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Hawke LD, Sheikhan NY, Rodak T. Lived experience and family engagement in psychiatry research: A scoping review of reviews. Health Expect 2024; 27:e14057. [PMID: 38678591 PMCID: PMC11056206 DOI: 10.1111/hex.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/14/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND A growing body of research is addressing the process and science of engaging people with lived experience (PWLE) of mental health challenges and other psychiatric conditions, and family members, in research activities. OBJECTIVE This scoping review of reviews synthesizes literature reviews on the engagement of PWLE and family members in research across the field of psychiatry. METHOD Systematic searches were conducted in seven bibliographic databases. Records were independently screened first at the title and abstract level, then at the full-text level. Included were any literature synthesis studies published in English, French, or Spanish in any given year, focusing on the engagement of PWLE and/or family members in research within psychiatry. Twenty records were included. Data were extracted in a spreadsheet and codebook thematic analysis was used across the body of articles to synthesize the findings. RESULTS Aspects of PWLE engagement have been synthesized in 20 review articles reviewing 376 articles across psychiatry as a whole and several subpopulations, including youth mental health, dementia, neurodevelopmental disorders, people who use drugs, and forensic mental health. Information specific to family engagement is lacking. Barriers, facilitators, and positive impacts of PWLE engagement have been widely reported across domains of research, with a considerable degree of consensus across subpopulations. Some negative impacts and reporting challenges have also been identified. DISCUSSION This scoping review of reviews provides an overarching understanding of the current state of the science of PWLE and family engagement across psychiatry research. The findings can inform future research practices enriched with a genuine and effective engagement with PWLE and families. PATIENT OR PUBLIC CONTRIBUTION The authorship team includes members with intersecting lived experience and academic identities. Additional lived experience engagement was not conducted as part of this review.
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Affiliation(s)
- Lisa D. Hawke
- University of TorontoTorontoCanada
- Centre for Addiction and Mental HealthTorontoCanada
| | - Natasha Y. Sheikhan
- University of TorontoTorontoCanada
- Centre for Addiction and Mental HealthTorontoCanada
| | - Terri Rodak
- Centre for Addiction and Mental HealthTorontoCanada
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Nixdorf R, Kotera Y, Baillie D, Garber Epstein P, Hall C, Hiltensperger R, Korde P, Moran G, Mpango R, Nakku J, Puschner B, Ramesh M, Repper J, Shamba D, Slade M, Kalha J, Mahlke C. Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries. PLoS One 2024; 19:e0298315. [PMID: 38408108 PMCID: PMC10896522 DOI: 10.1371/journal.pone.0298315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. METHOD Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. RESULTS 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. DISCUSSION Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.
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Affiliation(s)
- Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yasuhiro Kotera
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Dave Baillie
- East London NHS Foundation Trust, London, United Kingdom
| | - Paula Garber Epstein
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Cerdic Hall
- East London NHS Foundation Trust, London, United Kingdom
| | | | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Richard Mpango
- Butabika National Referral Hospital, Kampala, Uganda
- School of Health Sciences, Soroti University, Soroti, Uganda
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Juliet Nakku
- Butabika National Referral Hospital, Kampala, Uganda
- Makerere University, Kampala, Uganda
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Julie Repper
- ImROC, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Donat Shamba
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Haun M, Adler Ben-Dor I, Hall C, Kalha J, Korde P, Moran G, Müller-Stierlin AS, Niwemuhwezi J, Nixdorf R, Puschner B, Ramesh M, Charles A, Krumm S. Perspectives of key informants before and after implementing UPSIDES peer support in mental health services: qualitative findings from an international multi-site study. BMC Health Serv Res 2024; 24:159. [PMID: 38302955 PMCID: PMC10835950 DOI: 10.1186/s12913-024-10543-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Peer support is an essential part of recovery-oriented care worldwide. Contextual factors have an impact on the implementation of peer support work. However, research has paid little attention to similarities and differences of implementation factors in settings varying by income-level and cultural values. The aim of this study is to assess the factors influencing the implementation of a peer support intervention across study sites in low-, middle- and high-income countries in line with the Consolidation Framework for Implementation Research (CFIR). METHOD 6 focus groups with a total of 54 key informants with relevant contextual (organisational) knowledge regarding implementation facilitators and barriers were conducted at six study sites Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India) before and 1.5 years after the start of UPSIDES peer support. Transcripts were analysed using qualitative content analysis. RESULTS Across study sites key informants reported benefits of peer support for service users and peer support workers as implementation facilitators. At study sites with lower resources, reduced workload for mental health workers and improved access to mental health services through peer support were perceived as implementation facilitators (CFIR Domain 1: Intervention characteristics). The degree of engagement of mental health workers (CFIR Domain 3: Inner Setting/Domain 4: Individuals involved) varied across study sites and was seen either as a barrier (low engagement) or a facilitator (high engagement). Across study sites, adequate training of peer support workers (CFIR Domain 5: Implementation process) was seen as animplementation facilitator, while COVID-19 as well as low resource availability were reported as implementation barriers (CFIR Domain 2: Outer setting). CONCLUSIONS This study highlights the importance of considering contextual factors when implementing peer support, including previous experience and perceived benefits. Particular attention should be given to organisational benefits such as workload reduction and the allocation of sufficient resources as key drivers in LMICs. In HICs, the potential of organisational benefits for successful implementation should be further investigated and promoted.
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Affiliation(s)
- Maria Haun
- Department of Psychiatry II, Ulm University, Ulm, Germany.
| | - Inbar Adler Ben-Dor
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Cerdic Hall
- East London NHS Foundation Trust, London, UK
| | - Jasmine Kalha
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Palak Korde
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Galia Moran
- Department of Social Work, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | | | | | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Ulm, Germany
| | - Mary Ramesh
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Ashleigh Charles
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Silvia Krumm
- Department of Psychiatry II, Ulm University, Ulm, Germany
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Magnusson E, Tuvesson H, Rask M, Hörberg U. "A Lonely Road to Walk Along" - The Experiences of Being a Next of Kin to a Woman in Need of Compulsory Psychiatric Inpatient Care. Issues Ment Health Nurs 2023; 44:1245-1253. [PMID: 37852003 DOI: 10.1080/01612840.2023.2260481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
It is seldom that it is only the patient who is affected when someone is admitted to compulsory psychiatric inpatient care, the next of kin is usually also impacted. The aim was to describe the lived experiences of being a next of kin to a woman in need of compulsory psychiatric inpatient care. Ten next of kin were interviewed and the material was analyzed with a Reflective Lifeworld Research approach. The results show loneliness and feelings that their existence has collapsed. An emotional duality is described in the realization that the care is needed but they are devastated that the woman is there. A trust exists, but it changes when the next of kin are no longer a part of the care process.
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Affiliation(s)
- Emilie Magnusson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Hanna Tuvesson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Markström U, Näslund H, Schön UK, Rosenberg D, Bejerholm U, Gustavsson A, Jansson M, Argentzell E, Grim K, Engdahl P, Nouf F, Lilliehorn S, Svedberg P. Developing sustainable service user involvement practices in mental health services in Sweden: the "Userinvolve" research program protocol. Front Psychiatry 2023; 14:1282700. [PMID: 37900294 PMCID: PMC10601639 DOI: 10.3389/fpsyt.2023.1282700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/22/2023] [Indexed: 10/31/2023] Open
Abstract
Background The purpose of this paper is to outline the protocol for the research program "UserInvolve," with the aim of developing sustainable, service user involvement practices in mental health services in Sweden. Methods This protocol outlines the knowledge gap and aim of the UserInvolve-program. It further provides an overview of the research infrastructure, with specific focus on the organization and management of the program as well as the design of the six underlying research projects. These six research projects form the core of the UserInvolve-program and will be carried out during a six-year period (2022-2027). The projects are focused on examining articulations of experiential knowledge in user collectives, on four specific user involvement interventions (shared decision-making, peer support, user-focused monitoring, and systemic involvement methods) and on developing theory and method on co-production in mental health research and practice. Results or conclusion The knowledge gained through the co-production approach will be disseminated throughout the program years, targeting service users, welfare actors and the research community. Based on these research activities, our impact goals relate to strengthening the legitimacy of and methods for co-production in the mental health research and practice field.
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Affiliation(s)
| | - Hilda Näslund
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Ulla-Karin Schön
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | | | | | | | - Mårten Jansson
- The Swedish Partnership for Mental Health, NSPH, Stockholm, Sweden
| | | | - Katarina Grim
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
| | - Patrik Engdahl
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Faten Nouf
- Department of Social Work, Umeå University, Umeå, Sweden
| | | | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Jakobsson CE, Genovesi E, Afolayan A, Bella-Awusah T, Omobowale O, Buyanga M, Kakuma R, Ryan GK. Co-producing research on psychosis: a scoping review on barriers, facilitators and outcomes. Int J Ment Health Syst 2023; 17:25. [PMID: 37644476 PMCID: PMC10466887 DOI: 10.1186/s13033-023-00594-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Co-production is a collaborative approach to service user involvement in which users and researchers share power and responsibility in the research process. Although previous reviews have investigated co-production in mental health research, these do not typically focus on psychosis or severe mental health conditions. Meanwhile, people with psychosis may be under-represented in co-production efforts. This scoping review aims to explore the peer-reviewed literature to better understand the processes and terminology employed, as well as the barriers, facilitators, and outcomes of co-production in psychosis research. METHODS Three databases were searched (MEDLINE, EMBASE, PsycINFO) using terms and headings related to psychosis and co-production. All titles, abstracts and full texts were independently double-screened. Disagreements were resolved by consensus. Original research articles reporting on processes and methods of co-production involving adults with psychosis as well as barriers, facilitators, and/or outcomes of co-production were included. Data was extracted using a standardised template and synthesised narratively. Joanna Briggs Institute and the AGREE Reporting Checklist were used for quality assessment. RESULTS The search returned 1243 references. Fifteen studies were included: five qualitative, two cross-sectional, and eight descriptive studies. Most studies took place in the UK, and all reported user involvement in the research process; however, the amount and methods of involvement varied greatly. Although all studies were required to satisfy INVOLVE (2018) principles of co-production to be included, seven were missing several of the key features of co-production and often used different terms to describe their collaborative approaches. Commonly reported outcomes included improvements in mutual engagement as well as depth of understanding and exploration. Key barriers were power differentials between researchers and service users and stigma. Key facilitators were stakeholder buy-in and effective communication. CONCLUSIONS The methodology, terminology and quality of the studies varied considerably; meanwhile, over-representation of UK studies suggests there may be even more heterogeneity in the global literature not captured by our review. This study makes recommendations for encouraging co-production and improving the reporting of co-produced research, while also identifying several limitations that could be improved upon for a more comprehensive review of the literature.
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Affiliation(s)
- C E Jakobsson
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Eastbourne, England, UK.
| | - E Genovesi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, UK
| | - A Afolayan
- Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - T Bella-Awusah
- Department of Psychiatry & Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - O Omobowale
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - M Buyanga
- SUCCEED Africa, University of Zimbabwe, Harare, Zimbabwe
| | - R Kakuma
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, England, UK.
| | - G K Ryan
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, England, UK.
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Votruba N, Praveen D, Mellers L, Rajan E, Thout SR, Arora V, Malik Y, Kashyap A, Majumdar S, Hirst J, Maulik PK. SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India. Front Glob Womens Health 2023; 4:1143880. [PMID: 37575961 PMCID: PMC10416114 DOI: 10.3389/fgwh.2023.1143880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. Methods/design This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. Discussion The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.
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Affiliation(s)
- Nicole Votruba
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Devarsetty Praveen
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Mellers
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Eldho Rajan
- The George Institute for Global Health India, New Delhi, India
| | | | - Varun Arora
- Post Graduate Institute of Medical Science, Rohtak, India
| | - Yogender Malik
- Department of Psychiatry, Institute of Mental Health (IMH), University of Health Sciences PGIMS, Rohtak, India
| | - Aditya Kashyap
- SVS Institute of Neurosciences, Government Medical College, Siddipet, India
| | - Sreya Majumdar
- The George Institute for Global Health India, New Delhi, India
| | - Jane Hirst
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Pallab K. Maulik
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Gyimah L, Ofori-Atta A, Asafo S, Curry L. Seeking Healing for a Mental Illness: Understanding the Care Experiences of Service Users at a Prayer Camp in Ghana. JOURNAL OF RELIGION AND HEALTH 2023; 62:1853-1871. [PMID: 36066726 PMCID: PMC9986410 DOI: 10.1007/s10943-022-01643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Human rights abuses in mental health care are a global concern. Addressing the problem requires input from key stakeholders, particularly from people using mental health services. This study explored the experiences of persons with mental illness receiving care in a faith-based setting in Ghana. The study employed a qualitative design, with in-depth interviews (n = 23) and focus groups (n = 18 participants in 3 groups). The constant comparative method of analysis was used to identify themes in participants' descriptions of their experiences. The first three themes identified are consistent with human rights and coercion, and the last two themes related to service users' views on participation in spiritual practices. Themes included: decision-making around care; consent and efficacy of religious healing; experiences with chaining; views around biomedical treatment; participation in religious activities as part of healing and recognition of the need for spiritual healing. It was observed that participants with prior experience of psychiatric treatment were happy about the absence of chaining in psychiatric facilities but strongly disliked the side effects of medications. These findings underscore the need for faith-based institutions to provide care that is consistent with patient preferences, thereby helping to address the resultant human rights abuses.
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Affiliation(s)
- L Gyimah
- Pantang Hospital, P.O. Box PL81, Legon, Accra, Ghana.
| | - A Ofori-Atta
- Department of Psychiatry, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - S Asafo
- Department of Psychiatry, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - L Curry
- Yale University, New Haven, USA
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Vaiphei K, Yaresheemi S, Yang JMK, Di Florio A, Chandra PS, Thippeswamy H. Formation of a stakeholder group of women with a lived experience of Post-partum Psychoses (PP) - Experience from a perinatal psychiatry service in India. Asian J Psychiatr 2023; 84:103592. [PMID: 37079987 DOI: 10.1016/j.ajp.2023.103592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
Our paper describes the process of creating a stakeholder group for service development and research in Postpartum Psychosis (PP) at a Perinatal Psychiatry Service in India. We involved women who have recovered from PP as `experts by experience' in identifying areas that need attention from a research and service perspectives. A total of 13 group meetings were conducted, in which 9 group meetings involved women with lived experiences of PP and 4 group meetings were with the family members involved in the care of women during the PP episode. Of the 58 participants, 23 women and two family members expressed their willingness to participate in future stakeholder meetings. Involvement of women with PP and their caregivers as stakeholders in mental health decision-making appears feasible in a LMIC setting and should be encouraged.
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Affiliation(s)
- Kimneihat Vaiphei
- Department of Psychiatric Social Work, National Institute of Mental health and Neuro Sciences, India.
| | - Shivanand Yaresheemi
- Department of Psychiatric Social Work, National Institute of Mental health and Neuro Sciences, India
| | - Jessica M K Yang
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Arianna Di Florio
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, UK
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental health and Neurosciences, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental health and Neurosciences, India
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Encina-Zúñiga E, Agrest M, Tapia-Munoz T, Vidal-Zamora I, Ardila-Gómez S, Alvarado R, Leiderman EA, Reavley N. Development of mental health first-aid guidelines for depression: a Delphi expert consensus study in Argentina and Chile. BMC Psychiatry 2023; 23:161. [PMID: 36918853 PMCID: PMC10013290 DOI: 10.1186/s12888-023-04661-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. METHODS A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. RESULTS Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. CONCLUSIONS The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required.
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Affiliation(s)
- Esteban Encina-Zúñiga
- grid.443909.30000 0004 0385 4466School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- grid.443909.30000 0004 0385 4466Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Martín Agrest
- Proyecto Suma, Güemes 4130 (1425), Ciudad Autónoma de Buenos Aires, Argentina
| | - Thamara Tapia-Munoz
- grid.83440.3b0000000121901201Department of Behavioural Science and Health, University College London, London, UK
| | - Isidora Vidal-Zamora
- grid.443909.30000 0004 0385 4466Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sara Ardila-Gómez
- grid.7345.50000 0001 0056 1981Facultad de Psicología, Instituto de Investigaciones, Universidad de Buenos Aires, Buenos Aires, Argentina
- grid.423606.50000 0001 1945 2152Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Buenos Aires, Argentina
| | - Rubén Alvarado
- grid.443909.30000 0004 0385 4466School of Public Health, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- grid.412185.b0000 0000 8912 4050Department of Public Health, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Eduardo A. Leiderman
- grid.441624.10000 0001 1954 9157Departamento de Neurociencias, Facultad de Ciencias Sociales, Universidad de Palermo, Buenos Aires, Argentina
| | - Nicola Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria Australia
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11
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Tabatabaee M, Yousefi Nooraie R, Mohammad Aghaei A, Rostam-Abadi Y, Ansari M, Sharifi S, Sharifi V. Loneliness in the presence of others: A mixed-method study of social networks of caregivers of patients with severe mental disorders. Int J Soc Psychiatry 2023; 69:190-199. [PMID: 35148620 DOI: 10.1177/00207640221077580] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND One in four families has at least one member with a mental disorder and families are the main caregivers in most patients in low and middle-income countries. Caregivers experience disruption in their routine lives, increased responsibilities, increased need for support, and changes in their network. The role of personal support networks in the health and burden of the caregivers is complex and depends on the context, cultural and socioeconomical variables. In this study, we aimed to investigate the personal support network of caregivers of patients with severe mental illness in Iran. METHODS By using a mixed-methods design, we focused on the structure and composition of caregiver networks, as well as self-perceived caregiver support. RESULTS We found that the support network of caregivers was mostly composed of immediate family members whom themselves were selectively chosen as a result of the multidimensional process of interaction between stigma, availability, and the perceived needs of caregivers. The participants mentioned economic and instrumental supports more frequently than emotional support, probably reflecting their unmet basic needs. Advocacy for providing formal systemic supports to caregivers, as well as interventions that expand caregivers personal support network is recommended. CONCLUSIONS Most participants of the study were relatively isolated and had a small network of support, mostly composed of immediate family members. Stigma was a serious source of family distress for caregivers and a limiting factor in social relationships.
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Affiliation(s)
- Maryam Tabatabaee
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Yousefi Nooraie
- Department of Public Health Sciences, School of Medicine & Dentistry, University of Rochester, Rochester, NY, USA
| | | | - Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Ansari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shamim Sharifi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
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Scotti Requena S, Alves Assumpção T, Mesquita Peres CH, Vidotto Cerqueira A, Loch AA, Li W, Reavley NJ. Cultural adaptation of the mental health first aid guidelines for depression in Brazil: a Delphi expert consensus study. BMC Psychiatry 2023; 23:76. [PMID: 36707802 PMCID: PMC9881332 DOI: 10.1186/s12888-023-04566-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/24/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Depression is a significant contributor to disability in Brazil, with most Brazilians affected by depression receiving no treatment. As the community, including family and friends, plays a crucial role in providing support for someone with depression, it is important that evidence-based resources are available to support people who wish to help. The aim of this study was to culturally adapt the English-language mental health first aid guidelines for assisting a person with depression for the Brazilian culture. METHODS A Delphi expert consensus study was conducted, with two expert panels; health professionals (n = 29) and people with lived experience of depression (n = 28). One hundred and seventy-four statements from the English-language guidelines were translated into Brazilian Portuguese and administered as a survey. Participants were asked to rate statements based on how appropriate those statements were for the Brazilian culture and to suggest new statements if appropriate. RESULTS Data were collected over two survey rounds. Consensus was achieved on 143 statements. A total of 133 statements were adopted from the English-language guidelines, whereas 10 new endorsed statements were generated from suggestions of the two expert panels. CONCLUSIONS There were similarities between the English-language and Brazilian guidelines, mainly related to family involvement and the value of empathy. More research on dissemination and incorporation of the guidelines into the Mental Health First Aid (MHFA) training course for Brazil is required.
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Affiliation(s)
- Simone Scotti Requena
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Thais Alves Assumpção
- grid.11899.380000 0004 1937 0722Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Henrique Mesquita Peres
- grid.11899.380000 0004 1937 0722Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Amanda Vidotto Cerqueira
- grid.11899.380000 0004 1937 0722Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Andrade Loch
- grid.11899.380000 0004 1937 0722Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil ,grid.450640.30000 0001 2189 2026Instituto Nacional de Biomarcadores em Neuropsiquiatria (InBion), Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, São Paulo, Brazil
| | - Wenging Li
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Nicola J. Reavley
- grid.1008.90000 0001 2179 088XCentre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Baumann LA, Brütt AL. Comparing an in-person workshop and a postal Delphi survey for involving health service users in health care and health research prioritization. Health Expect 2022; 26:199-212. [PMID: 36346143 PMCID: PMC9854299 DOI: 10.1111/hex.13646] [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: 07/15/2022] [Revised: 09/13/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION To involve health service users in health care and health research priority setting, different methods exist. Which method is most suitable under which circumstances is unknown. We compared a postal Delphi survey and an in-person workshop to involve health service users in priority settings for rehabilitative care and research in Germany. METHODS One hundred and eighty-four former rehabilitants were randomly assigned to a postal Delphi survey (n = 152) or an in-person workshop (n = 32). Two hundred and seventy-six employees in rehabilitation were also invited to the Delphi Survey. The methodological comparison refers only to the sample of rehabilitants. Within each method, the participants agreed on the top 10 priorities for practice improvement and research in rehabilitative care. The priorities were compared descriptively. Participants' satisfaction was measured with the Public and Patient Engagement Evaluation Tool. The usability of both methods was compared based on the effort, time and material costs required for implementation. RESULTS Seventy-five former rehabilitants and 41 employees in rehabilitation completed both Delphi survey rounds. Eleven former rehabilitants participated in the in-person workshop. Priorities for practice improvement showed a high degree of overlap between both methods whereas research priorities differed greatly. Participants of the in-person workshop felt significantly better prepared, more listened to and more likely to feel that different views on the topics were discussed. Participants of the Delphi survey expressed difficulties in understanding all survey questions. The Delphi survey was more elaborate in preparation and implementation but caused lower material costs. CONCLUSION The differences in research priorities between the two methods could be due to the different samples, differences in the individual interests of participants or differences in the prioritization process. In-person workshops seem to be more appropriate for complex topics, where clarifications of questions and deeper discussions are needed. Delphi surveys seem to be more suitable for easily understandable topics, larger sample sizes and when fewer financial resources are available. PATIENT OR PUBLIC CONTRIBUTION The different study phases were supported by employees in rehabilitation and former rehabilitants (e.g., developing study documents, and interpreting results).
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Affiliation(s)
- Lisa Ann Baumann
- Department of Health Services ResearchCarl von Ossietzky University of OldenburgOldenburgGermany
| | - Anna L. Brütt
- Department of Health Services ResearchCarl von Ossietzky University of OldenburgOldenburgGermany
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14
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Krumm S, Haun M, Hiller S, Charles A, Kalha J, Niwemuhwezi J, Nixdorf R, Puschner B, Ryan G, Shamba D, Epstein PG, Moran G. Mental health workers' perspectives on peer support in high-, middle- and low income settings: a focus group study. BMC Psychiatry 2022; 22:604. [PMID: 36088330 PMCID: PMC9464408 DOI: 10.1186/s12888-022-04206-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer support is increasingly acknowledged as an integral part of mental health services around the world. However, most research on peer support comes from high-income countries, with little attention to similarities and differences between different settings and how these affect implementation. Mental health workers have an important role to play in integrating formal peer support into statutory services, and their attitudes toward peer support can represent either a barrier to or facilitator of successful implementation. Thus, this study investigates mental health workers' attitudes toward peer support across a range of high- (Germany, Israel), middle- (India), and low-income country (Tanzania, Uganda) settings. METHODS Six focus groups were conducted in Ulm and Hamburg (Germany), Butabika (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Ahmedabad, Gujarat (India) with a total of 35 participants. Transcripts were analyzed using thematic content analysis. RESULTS Participants across the study sites demonstrated overall positive attitudes towards peer support in mental health care, although some concerns were raised on potentially harmful effects of peer support such as negative role modelling and giving inadequate advice to service users. Notably, mental health workers from low- and middle-income countries described peer support workers as bridge-builders and emphasized the mutual benefits of peer support. Mental health workers' views on peer support workers' roles and role boundaries differed between sites. In some settings, mental health workers strongly agreed on the need for role clarity, whereas in others, mental health workers expressed mixed views, with some preferring blurred role boundaries. Regarding collaboration, mental health workers described peer support workers as supporters and utilizers, equal partners or emphasized a need for trust and commitment. CONCLUSIONS Mental health workers' attitudes toward peer support workers were positive overall, but they also varied depending on local context, resources and previous experiences with peer support. This affected their conceptions of peer support workers' roles, role clarity, and collaboration. This study demonstrated that reconciling the need for local adaptations and safeguarding the core values of peer support is necessary and possible, especially when the implementation of recovery-oriented interventions such as peer support is accelerating worldwide.
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Affiliation(s)
- Silvia Krumm
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany.
| | - Maria Haun
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Selina Hiller
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Ashleigh Charles
- grid.4563.40000 0004 1936 8868School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jasmine Kalha
- grid.32056.320000 0001 2190 9326Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Jackie Niwemuhwezi
- grid.461309.90000 0004 0414 2591Butabika National Referral Hospital, Kampala, Uganda
| | - Rebecca Nixdorf
- grid.13648.380000 0001 2180 3484Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Puschner
- grid.6582.90000 0004 1936 9748Department of Psychiatry and Psychotherapy II, Ulm University, Ulm/Guenzburg, Germany
| | - Grace Ryan
- grid.8991.90000 0004 0425 469XCentre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Donat Shamba
- grid.414543.30000 0000 9144 642XDepartment of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Paula Garber Epstein
- grid.12136.370000 0004 1937 0546Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Galia Moran
- grid.7489.20000 0004 1937 0511Department of Social Work, Ben Gurion University of the Negev, Be’er Sheva, Israel
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15
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Smith T, Wells L, Jones K, Jaouich A, Rush B. Assessing the Perception of Family and Caregivers' Experience with Mental Health and Substance Use Services. Int J Ment Health Addict 2022:1-16. [PMID: 35937612 PMCID: PMC9344803 DOI: 10.1007/s11469-022-00863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Standardized client feedback surveys encourage a culture of continuous quality improvement, allow for comparison of results over time and across similar types of service providers, and encourage use of evidence-based practices. Recognizing the importance of family and other caregivers in supporting people accessing services for mental health and substance use challenges, a standardized perception-of-care tool (the Ontario Perception of Care Tool for Mental Health and Addictions, OPOC-MHA) was adapted to collect feedback specific to the caregiver experience with these services. A collaborative process engaged a broad range of mental health and/or addiction providers, family advisory networks, and family members and caregivers to identify themes, specific items, and implementation approaches. The final version of the tool evolved through an iterative process of pilot testing and stakeholder feedback. Family member and caregiver perceptions of care will identify service areas in need of improvement, contribute to quality improvement initiatives, and facilitate the comparison of findings over time.
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Affiliation(s)
- Tayla Smith
- Provincial System Support Program, Center for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
| | - Leslie Wells
- Provincial System Support Program, Center for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
| | - Kelsey Jones
- Provincial System Support Program, Center for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
| | | | - Brian Rush
- Provincial System Support Program, Center for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1 Canada
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16
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Cluver LD, Sherr L, Toska E, Zhou S, Mellins CA, Omigbodun O, Li X, Bojo S, Thurman T, Ameyan W, Desmond C, Willis N, Laurenzi C, Nombewu A, Tomlinson M, Myeketsi N. From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:582-592. [PMID: 35750063 DOI: 10.1016/s2352-4642(22)00101-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 01/10/2023]
Abstract
Adolescents are a crucial generation, with the potential to bring future social and economic success for themselves and their countries. More than 90% of adolescents living with HIV reside in sub-Saharan Africa, where their mental health is set against a background of poverty, familial stress, service gaps, and an HIV epidemic that is now intertwined with the COVID-19 pandemic. In this Series paper, we review systematic reviews, randomised trials, and cohort studies of adolescents living with and affected by HIV. We provide a detailed overview of mental health provision and collate evidence for future approaches. We find that the mental health burden for adolescents living with HIV is high, contributing to low quality of life and challenges with adherence to antiretroviral therapy. Mental health provision is scarce, infrastructure and skilled providers are missing, and leadership is needed. Evidence of effective interventions is emerging, including specific provisions for mental health (eg, cognitive behavioural therapy, problem-solving, mindfulness, and parenting programmes) and broader provisions to prevent drivers of poor mental health (eg, social protection and violence prevention). We provide evidence of longitudinal associations between unconditional government grants and improved mental health. Combinations of economic and social interventions (known as cash plus care) could increase mental health benefits. Scalable delivery models include task sharing, primary care integration, strengthening families, and a pyramid of provision that differentiates between levels of need, from prevention to the care of severe disorders. A turning point has now been reached, from which complacency cannot persist. We conclude that there is substantial need, available frameworks, and a growing evidence base for action while infrastructure and skill acquisition is built.
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Affiliation(s)
- Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude-Ann Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA
| | - Olayinka Omigbodun
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Samuel Bojo
- Agency for Research and Development Initiative, Juba, South Sudan
| | - Tonya Thurman
- Highly Vulnerable Children Research Center, Cape Town, South Africa; Tulane University School of Public Health, New Orleans, LA, USA
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Chris Desmond
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Amahle Nombewu
- Teen Advisory Group, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Noxolo Myeketsi
- Department of Information Systems, University of the Western Cape, Cape Town, South Africa
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Considerations for supporting meaningful stakeholder engagement in global mental health research. Epidemiol Psychiatr Sci 2022; 31:e54. [PMID: 35856261 PMCID: PMC9305728 DOI: 10.1017/s204579602200035x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The need to ensure that research evidence is adopted by health systems and is informed by lived experience expertise has been increasingly recognised in mental health research. In the field of global mental health (GMH), though some progress has been made, the meaningful engagement of key stakeholders in research remains low. This editorial outlines recommendations to support the meaningful engagement of policy makers and people with lived or living experience of mental illness in GMH research. Recommendations include: increasing funding structures that are designed to support meaningful engagement; urging institutions to consider administrative structures that support engagement with lower resourced partners; promoting capacity development opportunities and resources to support researchers to promote meaningful engagement; developing research governance structures that include key stakeholders; and, taking steps to ensure the needs of diverse stakeholders are met through their engagement in research. Examples of good practice from these areas are provided. Though not an exhaustive list of recommendations, this editorial represents a call to the GMH research community to take a deliberate and proactive approach to prioritising meaningful stakeholder engagement in GMH research with the ultimate goal of improving accessible and appropriate mental health care.
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Abayneh S, Lempp H, Kohrt BA, Alem A, Hanlon C. Using participatory action research to pilot a model of service user and caregiver involvement in mental health system strengthening in Ethiopian primary healthcare: a case study. Int J Ment Health Syst 2022; 16:33. [PMID: 35818056 PMCID: PMC9275138 DOI: 10.1186/s13033-022-00545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background Little is known about actual involvement or how to achieve service user and caregiver in mental health systems strengthening in low-and middle-income countries. This study describes the processes and explores involvement experiences of participants in a pilot study of a new model of service user involvement in mental health system strengthening in a rural district in southern Ethiopia. Methods We applied a case study design using participatory action research (PAR). The PAR process comprised of three stages, each with iterative activities of plan, act, observe and reflect. Two stakeholder groups, a Research Advisory Group (RAG) and Research Participant Group (RPG), were established and collaborated in the PAR process. Data collection involved process documentation of meetings and activities: attendances, workshop minutes, discussion outputs, reflective notes, participatory observation of sessions, and in-depth interviews with 12 RPG members. We analyzed the process data descriptively. Thematic analysis was used for qualitative data. Triangulation and synthesis of findings was carried out to develop the case study. Results The stakeholder groups identified their top research priorities, developed an intervention and action plan and made a public presentation of preliminary findings. Key mechanisms used for inclusive participation included capacity building and bringing together diverse stakeholders, anchoring the study in established strong community involvement structures, and making use of participatory strategies and activities during the PAR process. Four themes were developed about experiences of involvement in PAR: (i) expectations and motivation, (ii) experiences of the dynamics of the PAR process, (iii) perceived impacts of involvement in the PAR process, and (iv) implementation challenges and future directions. Conclusions This case study demonstrated the feasibility and acceptability of implementing a complex model of service-user involvement in mental health system strengthening in a resource constrained setting. More needs to be done to embed service-user involvement into routines of the primary healthcare system, alongside sustained support and strengthening multi-stakeholder collaboration at multiple levels. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00545-8.
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Affiliation(s)
- Sisay Abayneh
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia. .,Madda Walabu University College of Education and Behavoural Studies, Bale Robe, Ethiopia.
| | - Heidi Lempp
- Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, Weston Education Centre, King's College London, 10, Cutcombe Rd, London, SE5 9RJ, UK
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Atalay Alem
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.,Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Abayneh S, Lempp H, Rai S, Girma E, Getachew M, Alem A, Kohrt BA, Hanlon C. Empowerment training to support service user involvement in mental health system strengthening in rural Ethiopia: a mixed-methods pilot study. BMC Health Serv Res 2022; 22:880. [PMID: 35799252 PMCID: PMC9264546 DOI: 10.1186/s12913-022-08290-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background Increased service user involvement is recommended to improve weak mental health systems in low-and middle-income countries (LMICs). However, involvement is rarely implemented and interventions to support involvement are sparse. In this study we evaluated the acceptability, feasibility and perceived outcomes of an empowerment and training program for service users and health professionals to facilitate service user involvement in mental health system strengthening in rural Ethiopia. Methods REducing Stigma among HealthcAreProvidErs (RESHAPE) is a training curriculum for service users, their caregivers and aspirational health workers, which uses PhotoVoice methodology, to prepare them in participation of mental health systems strengthening in LMICs. We delivered the RESHAPE training augmented with empowerment content developed in Ethiopia. The interactive face-to-face training was delivered to service users and caregivers (over 10 days), and health professionals (1 day) separately. The study was an uncontrolled, convergent mixed-methods design. The quantitative data consisted of process data, satisfaction questionnaire, and a retrospective pre-test survey. Qualitative data included exit and follow-up in-depth interviews with the service users. Descriptive statistics were performed for quantitative data, and qualitative data were thematically analysed. The findings were integrated through triangulation for convergent themes following analysis. Results Twelve service users, 12 caregivers and 18 health professionals were enrolled, and completed the training. Participants valued the content and delivery process; the standard of the training program met their expectations and participation led to positive gains in understanding about mental illness, stigma, service-user involvement and human rights. The qualitative findings identified positive impacts, including increased self-confidence, sense of empowerment, social - and perceived therapeutic benefits. Conclusions We found that the RESHAPE training with added content for Ethiopia, delivered using the PhotoVoice methodology, is feasible, acceptable and of value to develop and implement training programmes which can empower service users to be involved in mental health system strengthening in this setting. Further study to assess the impact on health systems strengthening is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08290-x.
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Affiliation(s)
- Sisay Abayneh
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia. .,Madda Walabu University College of Education and Behavoural Studies, Robe, Ethiopia.
| | - Heidi Lempp
- Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, Weston Education Centre 10, Cutcombe Rd., London, SE5 9RJ, UK
| | - Sauharda Rai
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Eshetu Girma
- Depatment of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Medhanit Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia
| | - Brandon A Kohrt
- Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Charlotte Hanlon
- College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
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Baumann LA, Reinhold AK, Brütt AL. Public and patient involvement in health policy decision-making on the health system level – A scoping review. Health Policy 2022; 126:1023-1038. [DOI: 10.1016/j.healthpol.2022.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022]
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Pearce T, Maple M, Wayland S, McKay K, Woodward A, Brooks A, Shakeshaft A. A mixed-methods systematic review of suicide prevention interventions involving multisectoral collaborations. Health Res Policy Syst 2022; 20:40. [PMID: 35422050 PMCID: PMC9009036 DOI: 10.1186/s12961-022-00835-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/06/2022] [Indexed: 11/15/2022] Open
Abstract
Background Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement. Methods The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed. Results Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co-design or co-evaluation stage. Conclusion This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the field of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed that the inclusion of co-researchers from communities or organizations is defined as co-creation, but further analysis revealed that collaboration was not consistent across the duration of projects. Researchers and practitioners should consider issues of power and equity in multisectoral collaborations and encourage increased engagement with TSOs, to rigorously research and evaluate suicide prevention services.
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Näslund H, Grim K, Markström U. User-Focused Monitoring as a Strategy for Involvement and Mental Health Service Development: An Analysis of Swedish Monitoring Reports. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2022; 9:303-316. [PMID: 35345414 PMCID: PMC8942048 DOI: 10.1007/s40737-022-00268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/02/2022] [Indexed: 06/14/2023]
Abstract
User-focused monitoring (UFM) is a method of evaluating mental health services, conducted by people with lived experience of mental ill health. Research on UFM and on user involvement focused on service monitoring and evaluation is lacking. This study addresses this knowledge gap by examining UFM as a strategy for user involvement. More specifically, this study aims to synthesize patterns in UFM reports to characterize the phenomenon, as well as to further discuss negotiation processes and political opportunities in UFM. The empirical material consists of 136 Swedish UFM reports that have been analyzed in two steps: All reports were mapped according to general characteristics and a sample of 20 reports were selected to provide additional information on the method. This study has been conducted in collaboration with actors representing the user movement and municipality-based mental health services. Our analysis shows that long-term contracts between user organizations and service providers are important to create a sustainable implementation of UFM. However, strategies to protect user autonomy must be carefully considered and employed in relation to such collaborations. We further highlight the risks of a restricted focus on consumer satisfaction, and discuss the current development towards including follow-ups in the UFM process as a strategy for counteracting tokenism.
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Affiliation(s)
- Hilda Näslund
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Katarina Grim
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
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Zengul FD, Oner N, Ozaydin B, Hall AG, Berner ES, Cimino JJ, Lemak CH. Mapping 2 Decades of Research in Health Services Research, Health Policy, and Health Economics Journals. Med Care 2022; 60:264-272. [PMID: 34984990 DOI: 10.1097/mlr.0000000000001685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify major research topics and exhibit trends in these topics in 15 health services research, health policy, and health economics journals over 2 decades. DATA SOURCES The study sample of 35,159 abstracts (1999-2020) were collected from PubMed for 15 journals. STUDY DESIGN The study used a 3-phase approach for text analyses: (1) developing the corpus of 40,618 references from PubMed (excluding 5459 of those without abstract or author information); (2) preprocessing and generating the term list using natural language processing to eliminate irrelevant textual data and identify important terms and phrases; (3) analyzing the preprocessed text data using latent semantic analysis, topic analyses, and multiple correspondence analysis. PRINCIPAL FINDINGS Application of analyses generated 16 major research topics: (1) implementation/intervention science; (2) HIV and women's health; (3) outcomes research and quality; (4) veterans/military studies; (5) provider/primary-care interventions; (6) geriatrics and formal/informal care; (7) policies and health outcomes; (8) medication treatment/therapy; (9) patient interventions; (10) health insurance legislation and policies; (11) public health policies; (12) literature reviews; (13) cost-effectiveness and economic evaluation; (14) cancer care; (15) workforce issues; and (16) socioeconomic status and disparities. The 2-dimensional map revealed that some journals have stronger associations with specific topics. Findings were not consistent with previous studies based on user perceptions. CONCLUSION Findings of this study can be used by the stakeholders of health services research, policy, and economics to develop future research agendas, target journal submissions, and generate interdisciplinary solutions by examining overlapping journals for particular topics.
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Affiliation(s)
| | | | | | | | | | - James J Cimino
- Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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Mbwayo A, Kumar M, Mathai M, Mutavi T, Nungari J, Gathara R, McKay M, Ssewamala F, Hoagwood K, Petersen I, Bhana A, Huang KY. Strengthening System and Implementation Research Capacity for Child Mental Health and Family Well-being in Sub-Saharan Africa. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022; 9:37-53. [PMID: 35330916 PMCID: PMC8939896 DOI: 10.1007/s40609-021-00204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children in Sub-Saharan Africa (SSA) experience high rates of mental health problems, and the region has limited access to mental health resources and research capacity to address the needs. Despite the success of numerous evidence-based interventions (EBIs) and emerging methodology from the field of implementation science for addressing child mental health needs, most EBIs and implementation science methodology have not been applied in SSA contexts. The SMART-Africa Center aims to address these child welfare, mental health, services, and EBI implementation research gaps by establishing a regional trans-disciplinary collaborative center and studying strategies to strengthening mental health system and implementation research capacity. Our paper describes the overall framework and strategies that SMART-Africa team developed to strengthen capacity in three SSA countries (Ghana, Kenya, and Uganda) while focusing on its contextualization for the Kenyan school-community mental health settings. Methods to document the progress and impacts are also described. METHODS The design of the system and research strengthening activities is guided by a SMART-Africa Capacity Building framework. Two areas of capacity are focused. Mental health system capacity focuses on building political wills, leadership, transdisciplinary partnership, and stakeholders' global competency in evidence child mental health policy, intervention, and service implementation research. Implementation research capacity building focuses on building researchers' implementation research competency by carrying out an EBI implementation research (using a Hybrid Type II effectiveness-implementation). For illustration purpose, we describe how the system strengthening strategies has been applied in Kenya, and how the mixed methods design applied to assess the value and impacts of the capacity building activities. Feedback data and evaluation data collection using qualitative and quantitative methods for both areas of capacity building are still ongoing. Data will be analyzed and compared across countries in 2020-2021. CONCLUSION Our work has shown some feasibility of applying the theory-guided system strengthening model in improving child mental health service system and research capacity in one of the three SMART-Africa partnering countries. Our mental health landscape and resource mapping in Kenya also illustrated that capacity building in SSA countries involved complex dynamic, history, and some overlap efforts with multiple partnerships, and these are critical to consider in training activity and evaluation design.
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Affiliation(s)
- Anne Mbwayo
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Manasi Kumar
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Muthoni Mathai
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Teresia Mutavi
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | | | | | - Mary McKay
- Washington University in St. Louis, St. Louis, USA
| | | | | | | | - Arvin Bhana
- South African Medical Research Council, Cape Town, South Africa
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Campion J, Javed A, Lund C, Sartorius N, Saxena S, Marmot M, Allan J, Udomratn P. Public mental health: required actions to address implementation failure in the context of COVID-19. Lancet Psychiatry 2022; 9:169-182. [PMID: 35065723 PMCID: PMC8776278 DOI: 10.1016/s2215-0366(21)00199-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022]
Abstract
Mental disorders account for at least 18% of global disease burden, and the associated annual global costs are projected to be US$6 trillion by 2030. Evidence-based, cost-effective public mental health (PMH) interventions exist to prevent mental disorders from arising, prevent associated impacts of mental disorders (including through treatment), and promote mental wellbeing and resilience. However, only a small proportion of people with mental disorders receive minimally adequate treatment. Compared with treatment, there is even less coverage of interventions to prevent the associated impacts of mental disorders, prevent mental disorders from arising, or promote mental wellbeing and resilience. This implementation failure breaches the right to health, has increased during the COVID-19 pandemic, and results in preventable suffering, broad impacts, and associated economic costs. In this Health Policy paper, we outline specific actions to improve the coverage of PMH interventions, including PMH needs assessments, collaborative advocacy and leadership, PMH practice to inform policy and implementation, training and improvement of population literacy, settings-based and integrated approaches, use of digital technology, maximising existing resources, focus on high-return interventions, human rights approaches, legislation, and implementation research. Increased interest in PMH in populations and governments since the onset of the COVID-19 pandemic supports these actions. Improved implementation of PMH interventions can result in broad health, social, and economic impacts, even in the short-term, which support the achievement of a range of policy objectives, sustainable economic development, and recovery.
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Affiliation(s)
- Jonathan Campion
- South London and Maudsley NHS Foundation Trust, London, UK; Public Mental Health Implementation Centre, Royal College of Psychiatrists, London, UK.
| | - Afzal Javed
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Crick Lund
- King's Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
| | - Shekhar Saxena
- Department of Global Health and Population at the Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Michael Marmot
- Institute of Health Equity, Department of Epidemiology and Public Health, UCL, London, UK
| | - John Allan
- Office of the President, Royal Australian and New Zealand College of Psychiatrists, Melbourne, VIC, Australia; Mental Health, Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia; Mayne Academy of Psychiatry, University of Queensland Medical School, University of Queensland, Brisbane, QLD, Australia
| | - Pichet Udomratn
- Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Dehbozorgi R, Fereidooni-Moghadam M, Shahriari M, Moghimi-Sarani E. Barriers to family involvement in the care of patients with chronic mental illnesses: A qualitative study. Front Psychiatry 2022; 13:995863. [PMID: 36339878 PMCID: PMC9627781 DOI: 10.3389/fpsyt.2022.995863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Caregivers are patients' family members or intimate friends who take care of individuals suffering from chronic mental illnesses without being paid. Evidence has supported the role of family-centered collaborative care in the treatment of patients with chronic mental illnesses. It has also been emphasized by national policies. However, carrying out this type of care is accompanied by challenges in Iran. Considering the importance of family participation in taking care of these patients as well as the necessity to determine its effective factors, the present study aimed to assess the barriers to family involvement in the care of patients with chronic mental illnesses. METHOD A conventional content analysis was used to conduct this qualitative study. Thirty four health care providers, patients, and caregivers were interviewed unstructured in-depth face-to-face using purposive sampling. Until saturation of data, sampling and data analysis were conducted simultaneously. Graneheim and Lundman's method was used to record, transcribe, and analyze the interviews. RESULT The results showed that there were many barriers to the collaboration of family in the care of patients with chronic mental illnesses. Accordingly, four main categories and twelve subcategories were extracted from the data as follows: "family-related barriers", "treatment-related factors", "disease nature threatening care", and "mental disease-associated stigma in the society". CONCLUSION The findings presented the barriers to family centers' collaborative care in patients with chronic mental illnesses and the necessary components of family involvement in the care to be used by healthcare managers and policymakers. The reported barriers emphasize the need for the development of structured approaches whose implementation is easy for health care providers, does not require a lot of time and resources, and can improve patient and family outcomes.
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Affiliation(s)
- Raziye Dehbozorgi
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mohsen Shahriari
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ebrahim Moghimi-Sarani
- Research Center for Psychiatry and Behavior Science, Shiraz University of Medical Sciences, Shiraz, Iran
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Owen E, Massazza A, Roberts B, Lokot M, Fuhr DC. “Nothing about us, without us”? A qualitative study of service user involvement in the development of lay-delivered psychological interventions in contexts affected by humanitarian crises. J Migr Health 2022; 5:100087. [PMID: 35243462 PMCID: PMC8885574 DOI: 10.1016/j.jmh.2022.100087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/28/2022] Open
Abstract
Background : Service user involvement has become increasingly prioritised within health research, and more recently, within mental health and psychosocial support (MHPSS). However, there is limited exploration of service user involvement in the development of lay-delivered MHPSS psychological interventions. The aim of this research was to investigate how service users have been involved in the development of lay-delivered psychological interventions for populations affected by humanitarian crises. Methods : Thirteen semi-structured interviews were conducted with respondents involved in randomized controlled trials (RCTs) of lay-delivered MHPSS psychological interventions, either as principal investigators or as focal points for service user involvement. Thematic data analysis used was used to analyse the data. Results : There was a common perception that service user involvement is vital to the development of lay-delivered psychological interventions, but there was concern about how that happened in practice. Respondents desired to increase service user involvement, but they either did not know how to do this into practice or felt that they lacked the resources to do so. Recommendations were made for strengthening involvement, such as employing service users onto research teams. However, legal difficulties in compensating service users for their work were raised. Conclusion : Service user involvement was viewed as vital in the development of lay delivered psychological interventions, but remains predominantly tokenistic, partly due to limited guidance, time, and finances. Guidelines could support more meaningful and ethical service user involvement in lay-delivered psychological interventions in areas affected by humanitarian crises.
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Affiliation(s)
- Emily Owen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, London, UK
| | - Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, London, UK
| | - Michelle Lokot
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, London, UK
| | - Daniela C. Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London WC1H 9SH, London, UK
- Corresponding author.
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Kohrt BA, Jordans MJD, Turner EL, Rai S, Gurung D, Dhakal M, Bhardwaj A, Lamichhane J, Singla DR, Lund C, Patel V, Luitel NP, Sikkema KJ. Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services: A Pilot Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2131475. [PMID: 34730821 PMCID: PMC8567115 DOI: 10.1001/jamanetworkopen.2021.31475] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care. OBJECTIVE To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs). DESIGN, SETTING, AND PARTICIPANTS This pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021. INTERVENTIONS In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives. MAIN OUTCOMES AND MEASURES Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining. RESULTS Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirty-four facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were -10.6 points (95% CI, -14.5 to -6.74 points) in RESHAPE and -2.79 points (-8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events. CONCLUSIONS AND RELEVANCE This pilot cluster randomized clinical trial found that procedures were feasible and acceptable for PCPs to be trained by PWLE. These pilot results will help inform a full trial to evaluate benefits of collaboration with PWLE during training of PCPs to reduce stigma and improve diagnostic accuracy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02793271.
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Affiliation(s)
- Brandon A. Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Mark J. D. Jordans
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- University of Amsterdam, Amsterdam, the Netherlands
| | - Elizabeth L. Turner
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Sauharda Rai
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Jackson School of International Studies, Department of Global Health, University of Washington, Seattle
| | - Dristy Gurung
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- Center for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Manoj Dhakal
- Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
- School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Anvita Bhardwaj
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Daisy R. Singla
- Campbell Family Mental Health Research Institute, Centre of Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld Tanenbaum Research Institute, Toronto, Ontario, Canada
| | - Crick Lund
- Center 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
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Sangath, Goa, India
| | | | - Kathleen J. Sikkema
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
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Baumann LA, Brütt AL. Participation preferences of health service users in health care decision-making regarding rehabilitative care in Germany-A cross-sectional study. Health Expect 2021; 25:125-137. [PMID: 34519382 PMCID: PMC8849223 DOI: 10.1111/hex.13356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/12/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Involving patients and citizens in health care decision-making is considered increasingly important in Germany. Participatory structures have been implemented, especially in rehabilitative care. However, it is unknown whether and to what extent German patients and citizens want to participate in decisions that exceed their own medical treatment. OBJECTIVE This study aimed to survey participation preferences and associated factors of health service users in decisions regarding rehabilitative care at micro, meso and macro levels. METHODS A questionnaire was sent to 3872 former rehabilitants. We collected participation preferences using the Control Preference Scale or an adapted form. Possible influencing factors were examined using logistic regression models. RESULTS The response rate was 5.7% (n = 217). At all decision-making levels, joint decision-making was preferred. At the macro level, preferences for actively participating were the highest. Preferences were significantly interrelated between decision-making levels. At the micro level, an orthopaedic indication significantly decreased the desire for participation compared to psychosomatic indications (odds ratio = 0.44, p = .019). DISCUSSION Participants wanted to be equally involved in decision-making as experts. Higher preferences for active participation at the macro level might be due to dissatisfaction with the current health care organisation and lack of trust in politicians. Compared to the general public, our study sample was older (73.3% between 50 and 69 years) and more often chronically ill-factors associated with increased participation preferences in the literature. CONCLUSION Contrary to the identified preferences, participation opportunities in the German health care system are rare. Further research on participation preferences and structures that enable meaningful involvement are needed.
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Affiliation(s)
- Lisa A Baumann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Anna L Brütt
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Abboah-Offei M, Gyasi Darkwa A, Ayim A, Ansah-Ofei AM, Dovlo D, Awoonor-Williams JK, Agongo EEA, Agyepong IA, Elsey H. Adapting the Community-based Health Planning and Services (CHPS) to engage poor urban communities in Ghana: protocol for a participatory action research study. BMJ Open 2021; 11:e049564. [PMID: 34315798 PMCID: PMC8317127 DOI: 10.1136/bmjopen-2021-049564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/13/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION With rapid urbanisation in low-income and middle-income countries, health systems are struggling to meet the needs of their growing populations. Community-based Health Planning and Services (CHPS) in Ghana have been effective in improving maternal and child health in rural areas; however, implementation in urban areas has proven challenging. This study aims to engage key stakeholders in urban communities to understand how the CHPS model can be adapted to reach poor urban communities. METHODS AND ANALYSIS A Participatory Action Research (PAR) will be used to develop an urban CHPS model with stakeholders in three selected CHPS zones: (a) Old Fadama (Yam and Onion Market community), (b) Adedenkpo and (c) Adotrom 2, representing three categories of poor urban neighbourhoods in Accra, Ghana. Two phases will be implemented: phase 1 ('reconnaissance phase) will engage and establish PAR research groups in the selected zones, conduct focus groups and individual interviews with urban residents, households vulnerable to ill-health and CHPS staff and key stakeholders. A desk review of preceding efforts to implement CHPS will be conducted to understand what worked (or not), how and why. Findings from phase 1 will be used to inform and co-create an urban CHPS model in phase 2, where PAR groups will be involved in multiple recurrent stages (cycles) of community-based planning, observation, action and reflection to develop and refine the urban CHPS model. Data will be managed using NVivo software and coded using the domains of community engagement as a framework to understand community assets and potential for engagement. ETHICS AND DISSEMINATION This study has been approved by the University of York's Health Sciences Research Governance Committee and the Ghana Health Service Ethics Review Committee. The results of this study will guide the scale-up of CHPS across urban areas in Ghana, which will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content. This study is also funded by the Medical Research Council, UK.
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Affiliation(s)
| | - Akosua Gyasi Darkwa
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | - Andrews Ayim
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | | | - Delanyo Dovlo
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Greater Accra, Ghana
| | | | | | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
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Greene MC, Huang TTK, Giusto A, Lovero KL, Stockton MA, Shelton RC, Dos Santos P, Saúte F, Wainberg ML. Leveraging Systems Science to Promote the Implementation and Sustainability of Mental Health and Psychosocial Interventions in Low- and Middle-Income Countries. Harv Rev Psychiatry 2021; 29:262-277. [PMID: 34241978 PMCID: PMC9162158 DOI: 10.1097/hrp.0000000000000306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Advancements in global mental health implementation research have revealed promising strategies for improving access to evidence-based mental health care. These advancements have not translated, however, into a reduced prevalence of mental disorders. In this review we examine the relationships between determinants (i.e., barriers and facilitators) and outcomes of mental health services in low- and middle-income countries to identify opportunities for improving the population-level impact and sustainability of innovations in global mental health. We identified three key implementation and services outcomes that influenced the prevalence of mental disorders in the 56 included review articles: supply (access, implementation), demand (help seeking, utilization), and quality (effectiveness, quality of care) of mental health services. Determinants of these outcomes revealed seven themes: community stakeholder engagement; cultural relevance; stigma; human resource capacity; organization of services; governance, policy, and financing; and sociopolitical and community context. We developed a causal loop diagram to illustrate the relationships among these determinants and outcomes. The causal loop diagram revealed the central role of community stakeholder engagement in bridging implementation and patient outcomes, the importance of addressing stigma and social determinants of mental health, and the need to complement supply-side implementation strategies with approaches to equilibrate demand and improve the quality of services. Applying systems science methodologies to global mental health research presents an opportunity to examine the complex relationships among community and health system factors that influence implementation of evidence-based interventions in order to identify sustainable approaches to improve the population-level impact of mental health services in low- and middle-income countries.
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Affiliation(s)
- M Claire Greene
- From the Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health (Dr. Greene) and Department of Sociomedical Science (Dr. Shelton), Columbia University Mailman School of Public Health; Center for Systems and Community Design and Department of Health Policy and Management, City University of New York Graduate School of Public Health and Health Policy (Dr. Huang); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons & New York State Psychiatric Institute (Drs. Giusto, Lovero, Stockton, and Wainberg); Mental Health Department, Center for Applied Psychology and Psychometric Tests, Mozambique Ministry of Health (Dr. dos Santos); Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique (Dr. Saúte)
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Kola L, Kohrt BA, Hanlon C, Naslund JA, Sikander S, Balaji M, Benjet C, Cheung EYL, Eaton J, Gonsalves P, Hailemariam M, Luitel NP, Machado DB, Misganaw E, Omigbodun O, Roberts T, Salisbury TT, Shidhaye R, Sunkel C, Ugo V, van Rensburg AJ, Gureje O, Pathare S, Saxena S, Thornicroft G, Patel V. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. Lancet Psychiatry 2021; 8:535-550. [PMID: 33639109 PMCID: PMC9764935 DOI: 10.1016/s2215-0366(21)00025-0] [Citation(s) in RCA: 337] [Impact Index Per Article: 112.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Most of the global population live in low-income and middle-income countries (LMICs), which have historically received a small fraction of global resources for mental health. The COVID-19 pandemic has spread rapidly in many of these countries. This Review examines the mental health implications of the COVID-19 pandemic in LMICs in four parts. First, we review the emerging literature on the impact of the pandemic on mental health, which shows high rates of psychological distress and early warning signs of an increase in mental health disorders. Second, we assess the responses in different countries, noting the swift and diverse responses to address mental health in some countries, particularly through the development of national COVID-19 response plans for mental health services, implementation of WHO guidance, and deployment of digital platforms, signifying a welcome recognition of the salience of mental health. Third, we consider the opportunity that the pandemic presents to reimagine global mental health, especially through shifting the balance of power from high-income countries to LMICs and from narrow biomedical approaches to community-oriented psychosocial perspectives, in setting priorities for interventions and research. Finally, we present a vision for the concept of building back better the mental health systems in LMICs with a focus on key strategies; notably, fully integrating mental health in plans for universal health coverage, enhancing access to psychosocial interventions through task sharing, leveraging digital technologies for various mental health tasks, eliminating coercion in mental health care, and addressing the needs of neglected populations, such as children and people with substance use disorders. Our recommendations are relevant for the mental health of populations and functioning of health systems in not only LMICs but also high-income countries impacted by the COVID-19 pandemic, with wide disparities in quality of and access to mental health care.
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Affiliation(s)
- Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry, George Washington University, Washington, DC, USA
| | - Charlotte Hanlon
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Siham Sikander
- Global Health Department, Health Services Academy, Islamabad, Pakistan; Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Corina Benjet
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eliza Yee Lai Cheung
- The Reference Centre for Psychosocial Support, International Federation of the Red Cross and Red Crescent, Hong Kong Special Administrative Region, China; The Red Cross of the Hong Kong Special Administrative Region of China, Hong Kong Special Administrative Region, China
| | - Julian Eaton
- CBM Global and Centre for Global Mental Health, London, UK
| | - Pattie Gonsalves
- Wellcome-DBT India Alliance, Sangath, New Delhi, India; School of Psychology, University of Sussex, Brighton, UK
| | - Maji Hailemariam
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Daiane B Machado
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Centre for Data and Knowledge Integration for Health, CIDACS-FIOCRUZ, Bahia, Brazil
| | - Eleni Misganaw
- Mental Health Service Users Association Ethiopia, Addis Ababa, Ethiopia; Global Mental Health Peer Network, Pretoria, South Africa
| | - Olayinka Omigbodun
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; Centre for Child and Adolescent Mental Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tessa Roberts
- Centre for Society and Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; WHO Collaborating Centre for Research and Training in Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Charlene Sunkel
- Global Mental Health Peer Network, Johannesburg, South Africa
| | - Victor Ugo
- Mentally Aware Nigeria Initiative, Lagos, Nigeria; United for Global Mental Health, London, UK
| | - André Janse van Rensburg
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Centre for Health Systems Research and Development, Faculty of Humanities, University of the Free State, Bloemfontein, South Africa
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Graham Thornicroft
- Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Implementation Science, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Wellcome-DBT India Alliance, Sangath, New Delhi, India
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Baumann LA, Brütt AL. Public and patient involvement (PPI) in health policy decisionmaking on the health system-level: protocol for a systematic scoping review. BMJ Open 2021; 11:e043650. [PMID: 34011588 PMCID: PMC8137161 DOI: 10.1136/bmjopen-2020-043650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Public and patient involvement (PPI) in healthcare decisions at the health system-level (macro-level) has become increasingly important during recent years. Existing evidence indicates that PPI increase patient centredness and the democracy of healthcare decisions as well as patients' trust and acceptance of these decisions. However, different methods for PPI exist, and an overview of the outcomes and influential contextual factors has not yet been conducted. Therefore, this scoping review aims to provide an overview of the different methods used for PPI in health system decisionmaking and the reported outcomes and contextual factors for these methods. METHODS AND ANALYSIS The structure of this protocol is guided by the advanced scoping studies framework of Arksey and O' Malley, developed by Levac, Colquhoun and O'Brien, and the PRISMA-ScR Statement. We will systematically search electronic databases (MEDLINE, Cochrane Library, Scopus, CINAHL, PDQ-Evidence, Web of Science and PsycINFO) for peer-reviewed literature and screen the reference lists of included studies. Additionally, we will search for relevant grey literature and consult experts from the field to identify further information. Studies focusing on PPI in the context of health policy decision-making at the macro-level will be eligible for full-text screening. Studies focusing on decisions at the individual treatment-level (micro-level) and the organisational-level (mesolevel) as well as those dealing with PPI in health research will be excluded. A qualitative analysis will dissect how the included studies define PPI and its desirable outcomes, the achieved outcomes and reported contextual factors. ETHICS AND DISSEMINATION We will present the results at relevant conferences and in an open-access journal. Additionally, we will share them with the experts involved in the research process and consider ways in which to transfer the findings into practice. As only secondary and previously published information will be used, ethical approval is not necessary.
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Affiliation(s)
- Lisa Ann Baumann
- Department for Health Services Research, University of Oldenburg School of Medicine and Health Sciences, Oldenburg, Germany
| | - Anna Levke Brütt
- Department for Health Services Research, University of Oldenburg School of Medicine and Health Sciences, Oldenburg, Germany
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Ling R, Sit HF, Balaji S, Lam AI, Latkin CA, Tucker JD, Hall BJ. Crowdsourcing to design a marketing package to promote a WHO digital mental health intervention among Chinese young adults. Internet Interv 2021; 25:100397. [PMID: 34036050 PMCID: PMC8138601 DOI: 10.1016/j.invent.2021.100397] [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: 07/21/2020] [Revised: 03/09/2021] [Accepted: 04/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Digital mental health is an emerging field that can leverage technology and mobile apps to deliver mental health treatment to populations in areas with limited mental health services. Despite widespread availability of these apps, uptake remains low. Enhanced marketing is necessary to increase public engagement. There is growing recognition that mental health intervention beneficiaries should be engaged in all phases of treatment development, adaptation, and delivery. Crowdsourcing - consulting the public to solve problems and sharing the solutions - can foster community-informed ideas for public health, but has yet been applied to digital mental health marketing. OBJECTIVE With the goal of engaging potential intervention beneficiaries in digital mental health dissemination, the current project implemented a digital mental health crowdsourcing designathon for Chinese college students in Macao SAR, China and evaluated the feasibility of the contest and the products. The contest asked participants to design marketing packages for Step-by-Step, a scalable WHO digital mental health intervention focusing on depression. METHODS Designathon participants, recruited from a global health class, were sorted into teams with balanced areas of expertise. Two judging panels - one of experts in relevant fields and another of Chinese college students - evaluated the marketing packages and selected finalists. The designathon was held in-person over four days and involved debriefing, workshops, a contest, and an awards ceremony. A parallel mixed-methods approach was applied, including qualitative feedback from judges and participants alongside quantitative data on participant satisfaction and depressive symptoms to enrich our understanding of the event. Additionally, based on judges' feedback given to participants, the communication packages of the contest were ranked. RESULTS 49 participants (8 teams of 6-7 members each) were involved in the designathon. Using a cutoff score of 10 on the Patient Health Questionnaire-9 (PHQ-9), 11.4% of participants had moderate or higher depressive symptoms. All teams successfully produced complete digital mental health marketing packages. Four finalists' packages were selected quantitatively with judges' scores and the top finalist's package was described by judges' comments as simple, thoughtful, and appealing, although not informative enough. Participants were overall satisfied with the designathon, but some mentioned that time was insufficient and that organization/instruction clarity could have been improved. CONCLUSIONS The designathon is a novel, feasible strategy to collect crowd input for the dissemination of a mental health intervention. Compared with traditional communication strategies, this bottom-up approach included and engaged potential intervention beneficiaries to take an active role in creating digital mental health marketing communication. Future contests should allow participants more time and reconsider aspects of event organization.
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Affiliation(s)
- Rui Ling
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hao Fong Sit
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China
| | - Suvasini Balaji
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China,Program in Public Health Studies, Johns Hopkins University, Baltimore, MD, USA
| | | | - Carl A. Latkin
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D. Tucker
- UNC Project China, University of North Carolina at Chapel Hill, USA,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian J. Hall
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,Corresponding author at: Global and Community Mental Health Research Group, New York University (Shanghai), 1555 Century Ave, Pudong, Shanghai 200122, People's Republic of China.
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Murphy J, Qureshi O, Endale T, Esponda GM, Pathare S, Eaton J, De Silva M, Ryan G. Barriers and drivers to stakeholder engagement in global mental health projects. Int J Ment Health Syst 2021; 15:30. [PMID: 33812375 PMCID: PMC8019163 DOI: 10.1186/s13033-021-00458-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Engagement with diverse stakeholders, including policy makers, care providers and service users and communities, is essential for successful implementation of global mental health interventions. Despite being a fundamental factor in the implementation process, evidence about challenges and drivers to stakeholder engagement is limited in the global mental health literature. Methods We conducted semi-structured qualitative interviews with 29 recipients of Grand Challenges Canada Global Mental Health funding to assess barriers and drivers to global mental health implementation across a portfolio of projects. We used framework analysis to identify key themes related to implementation barriers and drivers. This paper reports on barriers and drivers to stakeholder engagement, with results related to capacity development and service delivery reported elsewhere in this journal. Results Barriers and drivers to stakeholder engagement were identified across four themes: (1) Contextual Considerations, (2) Resources, (3) Participation, Uptake and Empowerment, and (4) Stigma. While complex contextual challenges create barriers, mechanisms such as formative research can facilitate a deeper contextual understanding that supports effective implementation planning. Limited financial and human resources and competing priorities can lead to substantial challenges. Investing in and leveraging existing local resources and expertise can help to mitigate these barriers. The challenge of achieving active participation from stakeholders and diverging expectations about the nature of participation were identified as barriers, while providing opportunities for meaningful participation and empowerment acted as drivers. Stigma at the institutional, community and individual level was also identified as a substantial barrier to engagement. Conclusion The findings of this study are relevant to implementers in global mental health. They also have implications for global mental health funding agencies and policy organizations, who can support improved stakeholder engagement by investing in high-quality formative research, supporting capacity building for policy engagement, investing in longer-term funding schemes to support sustainable partnerships and scale-up, thus fostering successful engagement and supporting effective implementation of global mental health innovations.
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Affiliation(s)
- Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Onaiza Qureshi
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Georgina Miguel Esponda
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, 411004, India
| | - Julian Eaton
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Mary De Silva
- Wellcome Trust, 215 Euston Road, London, NW1 2BE, UK
| | - Grace Ryan
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
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Policymaking through a knowledge lens: Using the embodied-enacted-inscribed knowledge framework to illuminate the transfer of knowledge in a mental health policy consultation process - A South African case study. PLoS One 2021; 16:e0244940. [PMID: 33439892 PMCID: PMC7806173 DOI: 10.1371/journal.pone.0244940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
Background Marrying principles of evidence-based policymaking, with its focus on what works, with principles of consultative policymaking, with its focus on what works for whom, means finding ways to integrate multiple knowledge inputs into policy decisions. Viewed through the lens of the embodied-enacted-inscribed knowledge framework, policy consultation is a site of knowledge enactment, where the embodied knowledge enacted by individuals engages with the inscribed knowledge contained in policy documents, creating new forms of embodied and inscribed knowledge that move beyond these spaces. Aim Using this knowledge framework, this study aimed to trace the movement of knowledge inputs through South Africa’s mental health policy consultation summit. Methods Breakaway group session transcripts from the national consultation summit were thematically analysed to identify the types of knowledge that participants explicitly drew on (experiential or evidence-based) during discussions and how these knowledge inputs were used, responded to, and captured. Findings Findings suggest that there was little explicit reference to either evidence-based or experiential knowledge in most of the talk. While slightly more evidence-based than experiential knowledge claims were made, this did not render these claims any more likely to be responded to or engaged with in group discussions, or to be inscribed in group recommendations. Discussion The importance of designing participatory processes that enable optimal use of knowledge inputs in these enacted spaces is discussed. Conclusion Attending to the specific ways in which knowledge is transformed and moved through a policy consultation process has the potential to enhance the value that consultation offers policymakers.
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Vojtila L, Ashfaq I, Ampofo A, Dawson D, Selby P. Engaging a person with lived experience of mental illness in a collaborative care model feasibility study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:5. [PMID: 33419484 PMCID: PMC7796603 DOI: 10.1186/s40900-020-00247-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/20/2020] [Indexed: 05/26/2023]
Abstract
Researchers have explored different types of treatment to help people with a mental illness with other problems they might be experiencing, such as their health condition and quality of life. Care models that involve many different health care providers working together to provide complete physical and mental health care are becoming popular. There has been a push from the research community to understand the value of including people with lived experience in such programs. While research suggests that people with lived experience may help a patient's treatment, there is little evidence on including them in a team based program. This paper describes how our research team included a person with lived experience of psychosis in both the research and care process. We list some guiding principles we used to work through some of the common challenges that are mentioned in research. Lastly, experiences from the research team, lessons learned, and a personal statement from the person with lived experience (AA) are provided to help future researchers and people with lived experience collaborate in research and healthcare. Background In our current healthcare system, people with a mental illness experience poorer physical health and early mortality in part due to the inconsistent collaboration between primary care and specialized mental health care. In efforts to bridge this gap, hospitals and primary care settings have begun to take an integrated approach to care by implementing collaborative care models to treat a variety of conditions in the past decade. The collaborative care model addresses common barriers to treatment, such as geographical distance and lack of individualized, evidence-based, measurement-based treatment. Person(s) with lived experience (PWLE) are regarded as 'experts by experience' in the scope of their first-hand experience with a diagnosis or health condition. Research suggests that including PWLE in a patient's care and treatment has significant contributions to the patient's treatment and overall outcome. However, there is minimal evidence of including PWLE in collaborative care models. This paper describes the inclusion of a PWLE in a research study and collaborative care team for youth with early psychosis. Aims To discuss the active involvement of a PWLE on the research and collaborative care team and to describe the research team's experiences and perspectives to facilitate future collaborations. Method This paper describes the inclusion of a PWLE on our research team. We provide a selective review of the literature on several global initiatives of including PWLE in different facets of the healthcare system. Additionally, we outline multiple challenges of involving PWLE in research and service delivery. Examples are provided on how recruitment and involvement was facilitated, with the guidance of several principles. Lastly, we have included a narrative note from the PWLE included in our study, who is also a contributing author to this paper (AA), where she comments on her experience in the research study. Conclusion Including PWLE in active roles in research studies and collaborative care teams can enhance the experience of the researchers, collaborative care team members, and PWLE. We showcase our method to empower other researchers and service providers to continue to seek guidance from PWLE to provide more comprehensive, collaborative care with better health outcomes for the patient, and a more satisfying care experience for the provider.
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Affiliation(s)
- Lenka Vojtila
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada
| | - Iqra Ashfaq
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada
| | - Augustina Ampofo
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada
| | - Danielle Dawson
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada
| | - Peter Selby
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T1P, Canada.
- Addictions Research Program, Centre for Addiction and Mental Health, Toronto, Canada.
- Department of Family and Community Medicine; Department of Psychiatry; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Jansen R, Reid M. Interest in Communication Technology by Rural Caregivers of Adolescents with Mental Health Issues in South Africa: The Mmogo-Method ®. Issues Ment Health Nurs 2021; 42:24-37. [PMID: 32633169 DOI: 10.1080/01612840.2020.1774017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Caregivers determine the level of care adolescents with mental issues receive; however, caregivers' own needs are often unmet. Communication technology can be tailored to address these challenges, especially in a rural environment. This study aimed to explore caregivers' interest in using communication technology to provide support to address challenges. This study involved a visual-based narrative inquiry that gathered data through the Mmogo-method®. Three (n = 3) groups were held with rural caregivers (n = 17) of adolescents with mental health issues in a rural area in the Free State province of South Africa during 2017. Three themes captured challenges confronting caregivers, namely, psychosocial, social resources, and informational challenges. Interest in communication technology was captured in a fourth theme. The findings indicate that communication technology can address caregivers' challenges by providing support and information to caregivers in rural areas. Communication technology, including mobile phones, electronic devices, and the Internet, has transformed healthcare services and proved to be valuable in resource constraint environments.
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Affiliation(s)
- Ronelle Jansen
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Marianne Reid
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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Akhtar A, Malik A, Ghatasheh M, Aqel IS, Habashneh R, Dawson KS, Watts S, Jordans MJD, Brown F, Sijbrandij M, Cuijpers P, Bryant R. Feasibility trial of a brief scalable psychological intervention for Syrian refugee adolescents in Jordan. Eur J Psychotraumatol 2021; 12:1901408. [PMID: 34868475 PMCID: PMC8635577 DOI: 10.1080/20008198.2021.1901408] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Most refugees are less than 18 years and at heightened risk of common mental disorders (CMDs) relative to other youth. Limited evidence exists for psychosocial programsfor youth in low-resource settings. Early Adolescent Skills for Emotions (EASE) was developed by the World Health Organization to address this gap. OBJECTIVES This study tested the safety, feasibility, and trial procedures of the EASE intervention among Syrian refugee youth in preparation for a definitive randomized controlled trial (RCT). METHODS A feasibility RCT was conducted in Amman, Jordan with Syrian children aged 10-14 years who reported psychological distress. Following community screening, youth and their caregivers were randomized to receive either the EASE intervention or enhanced treatment as usual (ETAU). EASE comprised seven group sessions teaching children coping skills, and caregivers received three group sessions to augment the youth sessions. Assessments were conducted at baseline and 1 week following the last EASE session (8 weeks following baseline). Following the trial, a qualitative process evaluation with staff and beneficiaries took place. Primary outcomes were safety and feasibility indicators, and distress was measured by the Paediatric Symptom Checklist. RESULTS In November 2018, 179 children were screened; 61 (33%) met criteria for distress (34.1%), two were excluded for suicidal risk, and 59 were randomized (EASE = 33, ETAU = 26). Of those who received EASE, 26 children (79%) completed the intervention. Group attendance was high and no adverse events were reported in either arm. Psychological distress did not show signs of abating in either group over time. CONCLUSION This feasibility trial demonstrated the safety and acceptability of the intervention. Important lessons were learnt regarding entry criteria into the study and engagement of caregivers in the intervention. A fully powered randomized controlled trial will be conducted to evaluate the efficacy of EASE.
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Affiliation(s)
- Aemal Akhtar
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Aiysha Malik
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Maha Ghatasheh
- Institute for Family Health, King Hussein Foundation, Amman, Jordan
| | | | - Rand Habashneh
- Institute for Family Health, King Hussein Foundation, Amman, Jordan
| | - Katie S Dawson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sarah Watts
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Mark J D Jordans
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands.,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Felicity Brown
- Research and Development Department, War Child Holland, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
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Endale T, Qureshi O, Ryan GK, Esponda GM, Verhey R, Eaton J, De Silva M, Murphy J. Barriers and drivers to capacity-building in global mental health projects. Int J Ment Health Syst 2020; 14:89. [PMID: 33292389 PMCID: PMC7712613 DOI: 10.1186/s13033-020-00420-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/19/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The global shortage of mental health workers is a significant barrier to the implementation and scale-up of mental health services. Partially as a result of this shortage, approximately 85% of people with mental, neurological and substance-use disorders in low- and middle-income countries do not receive care. Consequently, developing and implementing scalable solutions for mental health capacity-building has been identified as a priority in global mental health. There remains limited evidence to inform best practices for capacity building in global mental health. As one in a series of four papers on factors affecting the implementation of mental health projects in low- and middle-income countries, this paper reflects on the experiences of global mental health grantees funded by Grand Challenges Canada, focusing on the barriers to and drivers of capacity-building. METHODS Between June 2014 and May 2017, current or former Grand Challenges Canada Global Mental Health grantees were recruited using purposive sampling. N = 29 grantees participated in semi-structured qualitative interviews, representing projects in Central America and the Caribbean (n = 4), South America (n = 1), West Africa (n = 4), East Africa (n = 6), South Asia (n = 11) and Southeast Asia (n = 3). Based on the results of a quantitative analysis of project outcomes using a portfolio-level Theory of Change framework, six key themes were identified as important to implementation success. As part of a larger multi-method study, this paper utilized a framework analysis to explore the themes related to capacity-building. RESULTS Study participants described barriers and facilitators to capacity building within three broad themes: (1) training, (2) supervision, and (3) quality assurance. Running throughout these thematic areas were the crosscutting themes of contextual understanding, human resources, and sustainability. Additionally, participants described approaches and mechanisms for successful capacity building. CONCLUSIONS This study demonstrates the importance of capacity building to global mental health research and implementation, its relationship to stakeholder engagement and service delivery, and the implications for funders, implementers, and researchers alike. Investment in formative research, contextual understanding, stakeholder engagement, policy influence, and integration into existing systems of education and service delivery is crucial for the success of capacity building efforts.
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Affiliation(s)
- Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 201th Street, New York, NY, 10027, USA.
| | - Onaiza Qureshi
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Grace Kathryn Ryan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Georgina Miguel Esponda
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ruth Verhey
- Research Support Centre, University of Zimbabwe, Harare, Zimbabwe
| | - Julian Eaton
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
- CBM Global, Bensheim, Germany
| | - Mary De Silva
- Department of Population Health, Wellcome Trust, London, UK
| | - Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Sanfilippo KRM, McConnell B, Cornelius V, Darboe B, Huma HB, Gaye M, Ceesay H, Ramchandani P, Cross I, Glover V, Stewart L. Community psychosocial music intervention (CHIME) to reduce antenatal common mental disorder symptoms in The Gambia: a feasibility trial. BMJ Open 2020; 10:e040287. [PMID: 33234641 PMCID: PMC7684808 DOI: 10.1136/bmjopen-2020-040287] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Examine the feasibility of a Community Health Intervention through Musical Engagement (CHIME) in The Gambia to reduce common mental disorder (CMD) symptoms in pregnant women. DESIGN Feasibility trial testing a randomised stepped-wedge cluster design. SETTING Four local antenatal clinics. PARTICIPANTS Women who were 14-24 weeks pregnant and spoke Mandinka or Wolof were recruited into the intervention (n=50) or control group (n=74). INTERVENTION Music-based psychosocial support sessions designed and delivered by all-female fertility societies. Sessions lasted 1 hour and were held weekly for 6 weeks. Delivered to groups of women with no preselection. Sessions were designed to lift mood, build social connection and provide health messaging through participatory music making. The control group received standard antenatal care. OUTCOMES Demographic, feasibility, acceptability outcomes and the appropriateness of the study design were assessed. Translated measurement tools (Self-Reporting Questionnaire (SRQ-20); Edinburgh Postnatal Depression Scale (EPDS)) were used to assess CMD symptoms at baseline, post-intervention and 4-week follow-up. RESULTS All clinics and 82% of women approached consented to take part. A 33% attrition rate across all time points was observed. 72% in the intervention group attended at least three sessions. Audio and video analysis confirmed fidelity of the intervention and a thematic analysis of participant interviews demonstrated acceptability and positive evaluation. Results showed a potential beneficial effect with a reduction of 2.13 points (95% CI (0.89 to 3.38), p<0.01, n=99) on the SRQ-20 and 1.98 points (95% CI (1.06 to 2.90), p<0.01, n=99) on the EPDS at the post-intervention time point for the intervention group compared with standard care. CONCLUSION Results demonstrate that CHIME is acceptable and feasible in The Gambia. To our knowledge, CHIME is the first example of a music-based psychosocial intervention to be applied to perinatal mental health in a low- and middle-income country context. TRIAL REGISTRATION NUMBER Pan African Clinical Trials Registry (PACTR201901917619299).
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Affiliation(s)
| | - Bonnie McConnell
- School of Music, The Australian National University, Canberra, New South Wales, Australia
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Buba Darboe
- The Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Hajara B Huma
- The Ministry of Health and Social Welfare, Banjul, The Gambia
- The National Centre for Arts and Culture, Banjul, The Gambia
| | - Malick Gaye
- The Ministry of Health and Social Welfare, Banjul, The Gambia
- The National Centre for Arts and Culture, Banjul, The Gambia
| | - Hassoum Ceesay
- The National Centre for Arts and Culture, Banjul, The Gambia
| | | | - Ian Cross
- Centre for Music & Science, Faculty of Music, University of Cambridge, Cambridge, UK
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lauren Stewart
- Psychology Department, Goldsmiths, University of London, London, UK
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Færden A, Bølgen B, Løvhaug L, Thoresen C, Dieset I. Patient satisfaction and acute psychiatric inpatient treatment. Nord J Psychiatry 2020; 74:577-584. [PMID: 32427019 DOI: 10.1080/08039488.2020.1764620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Patient satisfaction (PS) with treatment is one of different outcome- and quality measures used by health care providers worldwide to improve service. We report from a study of patients admitted to the Department of Acute Psychiatry at the Oslo University Hospital where we investigated PS and difference between genders, days of hospital stay, diagnostic groups, voluntary-and involuntary admitted patients according to hospital records and perceived voluntary-and involuntary admittance.Materials and methods: All admitted patients during a 9-month period in 2014 were asked to participate by written consent. We used The Psychiatric Inpatient Questionnaire (PIPEQ), a self-report survey validated for assessment post-discharge. Analyses were conducted for a general dimension of PS and individual questions. A user representative was a part of the study from the beginning.Results: A total of 357 patients were asked and 256 consented. Results show that 68% were over all satisfied and 14% dissatisfied. Highest PS was found for cooperation with relatives and lowest for influence on choice of treatment and medication. We found no significant difference in PS between men and women, but patients with a personality disorder and with short stay were less satisfied. PS was significantly less for those perceiving involuntary admission regardless of legal status.Conclusion: The PIPEQ gives important input of patient's experience with the delivery of care. Answers range from very much satisfied to not at all depending on what was asked for. Exploring PS provides valuable information for quality improvements for different patient groups.
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Affiliation(s)
- Ann Færden
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | | | - Lars Løvhaug
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | | | - Ingrid Dieset
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
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Carbonell Á, Navarro-Pérez JJ, Mestre MV. Challenges and barriers in mental healthcare systems and their impact on the family: A systematic integrative review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1366-1379. [PMID: 32115797 DOI: 10.1111/hsc.12968] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
The aim of this systematic integrative review is to analyse the challenges and barriers found in mental healthcare systems and the impact they have on the family. Searches were made of the Web of Science, Scopus, Medline and Cochrane databases using terms relating to mental health, family care and healthcare systems. We included and critically evaluated studies published in English between 2015 and 2019 that directly or indirectly analysed public mental health policies and the consequences they have for the family. We analysed our findings following the inductive content analysis approach. A total of 32 articles that met quality indicators were identified. Very closely related structural, cultural, economic and healthcare barriers were found that contribute to the treatment gap in mental health. The family covers the care systems' deficiencies and weaknesses, and this leads to overload and a diminishing quality of life for caregivers. It is acknowledged that people with mental illness and their families should be able to participate in the development of policies and thus contribute to strengthening mental healthcare systems worldwide.
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Affiliation(s)
- Ángela Carbonell
- Inter-University Research of Local Development (IidL) and Social Work and Social Services Department, University of Valencia, Valencia, Spain
| | - José-Javier Navarro-Pérez
- Inter-University Research of Local Development (IidL) and Social Work and Social Services Department, University of Valencia, Valencia, Spain
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Sandvin Olsson AB, Strøm A, Haaland-Øverby M, Fredriksen K, Stenberg U. How can we describe impact of adult patient participation in health-service development? A scoping review. PATIENT EDUCATION AND COUNSELING 2020; 103:1453-1466. [PMID: 32098746 DOI: 10.1016/j.pec.2020.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Patient participation represents a worldwide policy, but its impact lacks research. This study investigates impact of patient participation in health-service development by providing a comprehensive overview of how the literature describes it. METHOD A scoping review with a broad search strategy was conducted. The literature was examined for study characteristics, purpose for, approaches to and impact of patient participation. The data were analyzed using a thematic analysis. RESULTS The 34 included primary studies reported impacts of patient participation that were interpreted to constitute two categories: 1. The participatory process´ impact on involved patient representatives and health professionals, and the organization´s patient participation practice itself. 2. The participatory service development´s impact on the design and delivery of services regarding patients and health professionals, and the organization. CONCLUSION The literature describes a broad variation of impacts from health-service development, relevant for health professionals and patient representatives when initiating or participating in such processes. Our review provides an overview and discussion of these types of impact. PRACTICE IMPLICATIONS The findings can be of practical relevance to those aiming to develop services, quality indicators regarding effects of patient participation, or to further investigate aspects of participatory service development.
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Affiliation(s)
- Ann Britt Sandvin Olsson
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway; Center of diakonia, values and professional practice, VID Specialized University, Postboks 184 Vinderen, 0319 Oslo, Norway.
| | - Anita Strøm
- Faculty of Health Studies, VID Specialized University, Postboks 184 Vinderen, 0319 Oslo, Norway.
| | - Mette Haaland-Øverby
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
| | - Kari Fredriksen
- The Learning and Coping Center, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.
| | - Una Stenberg
- The Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Postboks 4959 Nydalen, 0424 Oslo, Norway.
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Abayneh S, Lempp H, Alem A, Kohrt BA, Fekadu A, Hanlon C. Developing a Theory of Change model of service user and caregiver involvement in mental health system strengthening in primary health care in rural Ethiopia. Int J Ment Health Syst 2020; 14:51. [PMID: 32760440 PMCID: PMC7379363 DOI: 10.1186/s13033-020-00383-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 07/18/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The involvement of service users and caregivers is recommended as a strategy to strengthen health systems and scale up quality mental healthcare equitably, particularly in low-and-middle-income countries. Service user and caregiver involvement is complex, and its meaningful implementation seems to be a worldwide challenge. Theory of Change (ToC) has been recommended to guide the development, implementation and evaluation of such complex interventions. This paper aims to describe a ToC model for service user and caregiver involvement in a primary mental health care in rural Ethiopia. METHODS The ToC was developed in two workshops conducted in (i) Addis Ababa with purposively selected psychiatrists (n = 4) and multidisciplinary researchers (n = 3), and (ii) a rural district in south-central Ethiopia (Sodo), with community stakeholders (n = 24). Information from the workshops (provisional ToC maps, minutes, audio recordings), and inputs from a previous qualitative study were triangulated to develop the detailed ToC map. This ToC map was further refined with written feedback and further consultative meetings with the research team (n = 6) and community stakeholders (n = 35). RESULTS The experiential knowledge and professional expertise of ToC participants combined to produce a ToC map that incorporated key components (community, health organisation, service user and caregiver), necessary interventions, preconditions, assumptions and indicators towards the long-term outcomes. The participatory nature of ToC by itself raised awareness of the possibilities for servicer user and caregiver involvement, promoted co-working and stimulated immediate commitments to mobilise support for a grass roots service user organization. CONCLUSIONS The ToC workshops provided an opportunity to co-produce a ToC for service user and caregiver involvement in mental health system strengthening linked to the planned model for scale-up of mental health care in Ethiopia. The next steps will be to pilot a multi-faceted intervention based on the ToC and link locally generated evidence to published evidence and theories to refine the ToC for broader transferability to other mental health settings.
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Affiliation(s)
- Sisay Abayneh
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
| | - Heidi Lempp
- Faculty of Life Sciences and Medicine, Centre for Rheumatic Diseases, School of Immunology and Microbial Sciences, King’s College London, Weston Education Centre 10, Cutcombe Rd, London, SE5 9RJ UK
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
| | - Brandon A. Kohrt
- Department of Psychiatry, George Washington University, Washington, DC USA
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
- College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, WHO Collaborating Centre in Mental Health Research and Capacity Building, Addis Ababa, Ethiopia
- College of Health Sciences, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
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Tamming T, Otake Y. Linking coping strategies to locally-perceived aetiologies of mental distress in northern Rwanda. BMJ Glob Health 2020; 5:e002304. [PMID: 32665374 PMCID: PMC7365432 DOI: 10.1136/bmjgh-2020-002304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION How and why people in a particular setting turn to a specific coping strategy for their distress is pivotal for strengthening mental healthcare and this needs to be understood from a local point of view. Prior research in northern Rwanda documented common local concepts of distress for the population that cannot receive assistance despite severe adversities; however, the locally-perceived causes, manifestation and coping strategies and their associations are still unclear. METHODS The qualitative study in the Musanze district, northern Rwanda, was informed by Interpretative Phenomenological Analysis. In-depth interviews were conducted with people with lived experience and those in close contact with people with lived experience of distress. Ethnographic observation was conducted and the analyses were complimented by an earlier ethnography in the same village. RESULTS Study participants (n=15) included community members with lived experience of mental distress and/or those with close friends or family with lived experience. The perceived manifestations of the mental distresses were diverse and the causal attributions shifted from more social, concrete and explainable (eg, loss) towards magical, more abstract and unexplainable (eg, poisoning). Finally, participants sought coping strategies in accordance with their causal attribution in ways that made sense to them. CONCLUSION The coping strategies were chosen according to the perceived aetiology of the symptoms and they were perceived to be effective for their distress. Local coping strategies that match people's help-seeking patterns should therefore be supported in policy and programmes. In Rwanda this requires a mutual training of medical professionals and traditional healers and establishing co-treatment within two parallel systems. This also requires the support for programmes and initiatives that strengthen positive interactions and change in circumstances.
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Affiliation(s)
- Teisi Tamming
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Yuko Otake
- School of Anthropology and Museum Ethnography, University of Oxford, Oxford, Oxfordshire, United Kingdom
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Shoesmith W, Chua SH, Giridharan B, Forman D, Fyfe S. Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi study. Int J Ment Health Syst 2020; 14:45. [PMID: 32577126 PMCID: PMC7304147 DOI: 10.1186/s13033-020-00374-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/30/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is strong evidence that collaborative practice in mental healthcare improves outcomes for patients. The concept of collaborative practice can include collaboration between healthcare workers of different professional backgrounds and collaboration with patients, families and communities. Most models of collaborative practice were developed in Western and high-income countries and are not easily translatable to settings which are culturally diverse and lower in resources. This project aimed to develop a set of recommendations to improve collaborative practice in Malaysia. METHODS In the first phase, qualitative research was conducted to better understand collaboration in a psychiatric hospital (previously published). In the second phase a local hospital level committee from the same hospital was created to act on the qualitative research and create a set of recommendations to improve collaborative practice at the hospital for the hospital. Some of these recommendations were implemented, where feasible and the outcomes discussed. These recommendations were then sent to a nationwide Delphi panel. These committees consisted of healthcare staff of various professions, patients and carers. RESULTS The Delphi panel reached consensus after three rounds. The recommendations include ways to improve collaborative problem solving and decision making in the hospital, ways to improve the autonomy and relatedness of patients, carers and staff and ways to improve the levels of resources (e.g. skills training in staff, allowing people with lived experience of mental disorder to contribute). CONCLUSIONS This study showed that the Delphi method is a feasible method of developing recommendations and guidelines in Malaysia and allowed a wider range of stakeholders to contribute than traditional methods of developing guidelines and recommendations.Trial registration Registered in the National Medical Research Register, Malaysia, NMRR-13-308-14792.
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Affiliation(s)
- Wendy Shoesmith
- Faculty of Medicine and Health Sciences, University Malaysia Sabah, Kota Kinabalu, Malaysia
- Curtin University, Miri, Sarawak Malaysia
| | - Sze Hung Chua
- Hospital Mesra Bukit Padang, Ministry of Health, Kota Kinabalu, Malaysia
| | | | - Dawn Forman
- School of Public Health, Curtin University, Perth, Australia
- University of Derby, Derby, UK
| | - Sue Fyfe
- School of Public Health, Curtin University, Perth, Australia
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Caregiver involvement in psychiatric inpatient treatment - a representative survey among triads of patients, caregivers and hospital psychiatrists. Epidemiol Psychiatr Sci 2020; 29:e129. [PMID: 32438939 PMCID: PMC7264704 DOI: 10.1017/s2045796020000426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Studies on the frequency of caregiver involvement in representative inpatient samples are scarce. The aim of our study was to conduct a representative survey on caregiver involvement in routine inpatient care involving all three parties (patients, caregivers, psychiatrists). Therefore, we performed face-to-face interviews consisting of open-ended questions to gain a deeper understanding of when and how caregivers are involved in care treatment and to identify which topics are mainly discussed. METHODS This cross-sectional survey included inpatients from 55 acute psychiatric wards across ten psychiatric hospitals, their treating psychiatrists and, when possible, their caregivers. In total, we performed semi-structured face-to-face interviews with 247 patients, their treating psychiatrists and 94 informal caregivers. Each psychiatrist named the next two to three patients to be discharged. After a patient had given informed consent, the interview was performed by a researcher. In addition, the psychiatrist and, when possible, the primary caregiver identified by the patient, were also interviewed. RESULTS It was perceived by both patients and psychiatrists that contact between caregiver and psychiatrist had taken place in one-third of the patient cases. Predictors for psychiatrist-caregiver-contact were revealed in the patient's diagnosis (schizophrenia), a lower history of inpatient stays, and the respective hospital. According to psychiatrists the most frequent subjects of discussion with caregivers involved therapeutic issues and organisational and social-psychiatric topics (e.g. work, living and social support). Patients and caregivers stated that psychiatric treatment and the diagnostic classification of the mental illness were the most frequent topics of conversation. For all three groups, the most often cited reason for missed caregiver involvement was the subjective perception that a caregiver was not in fact needed. CONCLUSIONS Whether or not caregivers were contacted and involved during an inpatient stay strongly depended on the individual hospital. The frequency of involvement of caregivers can certainly be increased by changing processes and structures in hospitals. All three parties (patients, caregivers and psychiatrists) most often stated that the caregiver was not involved in the treatment because they thought it was unnecessary. Evidence demonstrates the positive effect of caregivers' involvement on the therapeutic process but also on the well-being of the caregiver, therefore it is necessary to increase awareness of this evidence among all three interest groups.
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Irmansyah I, Susanti H, James K, Lovell K, Idaiani S, Imah S, Hargiana G, Keliat BA, Utomo B, Colucci E, Brooks H. Civic engagement and mental health system strengthening in Indonesia: a qualitative examination of the views of health professionals and national key stakeholders. BMC Psychiatry 2020; 20:172. [PMID: 32295558 PMCID: PMC7161291 DOI: 10.1186/s12888-020-02575-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/30/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mental health services in Indonesia are developing rapidly in response to national and global health policy to support people living with psychosis. This presents a unique opportunity for civic engagement, the active involvement of patients, carers and communities in mental health care, to shape emergent services. In-depth explorations of the views of professionals and other key stakeholders in mental health care on the use of civic engagement in Indonesia are lacking which contributes to a limited understanding of its potential in this regard. The study aimed to explore contemporary professionals' and other key stakeholders' perspectives on the current use of and potential for civic engagement to strengthen mental health systems in Indonesia. METHODS Qualitative interviews were undertaken and analysed using thematic analysis underpinned by a critical realist approach. Eighteen multi-disciplinary professionals and lay health workers involved in mental health care in Jakarta and Bogor and 10 national key stakeholders were recruited. RESULTS Despite high levels of awareness of and support for civic engagement amongst mental health professionals and policy makers combined with a nascent grass roots movement, analysis revealed unstructured and insufficient mechanisms for civic engagement which resulted in ad-hoc and mostly superficial levels of involvement activity. Civic engagement was thought to require a marked shift in existing practices as well as organisational and societal cultures. Challenging stigma is a key feature of civic engagement and our analysis highlights the relevance of social contact methods which are locally and culturally contextualised in this regard. Our findings point to a need to expand current definitions of civic engagement which focus on indivdiual enablement to ones that also encompass environmental and organisational enablement to optimise the future use of civic engagement in mental health settings. CONCLUSIONS Key mental health stakeholders have identified that central aspects of Indonesian culture are well aligned to the ethos of civic engagement which has the potential to facilitate the enactment of recent global health policy. However, full realisation is likely to be impeded by prevailing paternalistic cultures in mental health services and high levels of stigma and discrimination towards those with mental illness in Indonesia without intervention.
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Affiliation(s)
- Irman Irmansyah
- National Institute of Health Research and Development, Jakarta, Indonesia.,Marzoeki Mahdi Hospital, Bogor, Indonesia
| | - Herni Susanti
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Karen James
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston and St Georges, London, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sri Idaiani
- National Institute of Health Research and Development, Jakarta, Indonesia
| | - Soimah Imah
- National Institute of Health Research and Development, Jakarta, Indonesia
| | - Giur Hargiana
- Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | | | | | | | - Helen Brooks
- Department of Health Services Research, Institute of Population Health Sciences, University of Liverpool, Room B112, Waterhouse Building Block B, Liverpool, UK.
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Hall T, Kakuma R, Palmer L, Minas H, Martins J, Armstrong G. Service user and family participation in mental health policy making in Timor-Leste: a qualitative study with multiple stakeholders. BMC Psychiatry 2020; 20:117. [PMID: 32164633 PMCID: PMC7069011 DOI: 10.1186/s12888-020-02521-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participation in mental health system strengthening by people with mental health problems and their families is a cornerstone of people-centred mental health care, yet there is a dearth of research about participation from low- and middle-income countries (LMICs), particularly from the Asia Pacific region. Hence, this study aimed to assess the current situation, challenges, enabling factors and future actions for service user and family participation in mental health policy making in Timor-Leste. METHODS In-depth interviews were conducted with 85 adults (≥18 years) who were: (1) mental health service users (n = 20) and their families (n = 10); (2) government decision makers (n = 10); (3) mental health and social service providers (n = 23); (4) civil society (n = 9); and (5) other groups (n = 13). Interview data was analysed using framework analysis. RESULTS There was limited service user, family and community participation in mental health policy making in Timor-Leste. Perceptions that policy making is a technical exercise and that people with mental health problems lack cognitive capacity, and a lack of supportive mechanisms challenged participation. Enabling factors were a strong focus on human rights within the social sector, and existing mechanisms for advocacy and representation of people with disabilities in social policy making. Participants suggested bolstering civil society representation of people with mental health problems, and increasing mental health awareness and literacy, including government competencies to facilitate service user participation. CONCLUSION The findings highlight the need for theoretical and practical focus on the role of family within mental health system development in LMICs. Global mental health research and practice should adopt a critical approach to mental health service user and family participation to ensure that the concept and strategies to achieve this are embedded in LMIC knowledge.
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Affiliation(s)
- Teresa Hall
- Nossal Institute for Global Health, The University of Melbourne, Exhibition Street, Melbourne, 3004, Australia.
| | - Ritsuko Kakuma
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, UK ,grid.1008.90000 0001 2179 088XCentre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - Lisa Palmer
- grid.1008.90000 0001 2179 088XSchool of Geography, The University of Melbourne, Melbourne, Australia
| | - Harry Minas
- grid.1008.90000 0001 2179 088XCentre for Mental Health, The University of Melbourne, Melbourne, Australia
| | - João Martins
- grid.449369.5Faculty of Medicine and Health Sciences, National University of Timor-Leste, Dili, Timor-Leste
| | - Greg Armstrong
- grid.1008.90000 0001 2179 088XNossal Institute for Global Health, The University of Melbourne, Melbourne, Australia
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