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Ionescu A, Mannell J, Vaughan M, Burgess R. Misunderstood and underappreciated: a critical review of mental health advocacy and activism in low- and middle-income countries. Health Policy Plan 2024; 39:528-539. [PMID: 38441280 PMCID: PMC11095268 DOI: 10.1093/heapol/czae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 02/12/2024] [Accepted: 02/22/2024] [Indexed: 05/16/2024] Open
Abstract
Mental health advocacy and activism have been highlighted as important in the effort towards creating environments for better mental health. However, relevant research in low- and middle-income country settings remains limited and lacks critical exploration. We seek to contribute to filling this gap by exploring driving factors behind mental health advocacy and activism efforts in low- and middle-income country settings. This review uses a critically informed thematic analysis employing conceptual frameworks of productive power to analyse peer-reviewed articles on mental health advocacy or activism over the last 20 years. We suggest that the current body of research is marred by superficial explorations of activism and advocacy, partly due to a lack of cohesion around definitions. Based on our findings, we suggest a conceptual framework to guide deeper explorations of mental health advocacy and activism. This framework identifies 'legitimacy', 'context' and 'timing' as the main dimensions to consider in understanding activism and advocacy efforts. The fact that they remain misunderstood and underappreciated creates missed opportunities for meaningful inclusion of lived experience in policy decisions and limits our understanding of how communities envision and enact change.
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Affiliation(s)
- Alma Ionescu
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Jenevieve Mannell
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Megan Vaughan
- Institute for Advanced Studies, University College London, South Wing, Wilkins Building, Gower Street, London WC1E 6BT, United Kingdom
| | - Rochelle Burgess
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, United Kingdom
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Neill R, Shawar YR, Ashraf L, Das P, Champagne SN, Kautsar H, Zia N, Michlig GJ, Bachani AM. Prioritizing rehabilitation in low- and middle-income country national health systems: a qualitative thematic synthesis and development of a policy framework. Int J Equity Health 2023; 22:91. [PMID: 37198596 DOI: 10.1186/s12939-023-01896-5] [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: 01/28/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a large and growing unmet need for rehabilitation - a diverse category of services that aim to improve functioning across the life course - particularly in low- and middle-income countries. Yet despite urgent calls to increase political commitment, many low- and middle-income country governments have dedicated little attention to expanding rehabilitation services. Existing policy scholarship explains how and why health issues reach the policy agenda and offers applicable evidence to advance access to physical, medical, psychosocial, and other types of rehabilitation services. Drawing from this scholarship and empirical data on rehabilitation, this paper proposes a policy framework to understand national-level prioritization of rehabilitation in low- and middle-income countries. METHODS We conducted key informant interviews with rehabilitation stakeholders in 47 countries, complemented by a purposeful review of peer-reviewed and gray literature to achieve thematic saturation. We analyzed the data abductively using a thematic synthesis methodology. Rehabilitation-specific findings were triangulated with policy theory and empirical case studies on the prioritization of other health issues to develop the framework. RESULTS The novel policy framework includes three components which shape the prioritization of rehabilitation on low- and middle-income countries' national government's health agendas. First, rehabilitation lacks a consistent problem definition, undermining the development of consensus-driven solutions which could advance the issue on policy agendas. Second, governance arrangements are fragmented within and across government ministries, between the government and its citizens, and across national and transnational actors engaged in rehabilitation service provision. Third, national legacies - particularly from civil conflict - and weaknesses in the existing health system influences both rehabilitation needs and implementation feasibility. CONCLUSIONS This framework can support stakeholders in identifying the key components impeding prioritization for rehabilitation across different national contexts. This is a crucial step for ultimately better advancing the issue on national policy agendas and improving equity in access to rehabilitation services.
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Affiliation(s)
- Rachel Neill
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA.
| | - Yusra Ribhi Shawar
- Department of International Health, Johns Hopkins University Blomberg School of Public Health, Baltimore, MD, USA
- Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Washington, DC, USA
| | - Lamisa Ashraf
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Priyanka Das
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Sarah N Champagne
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Hunied Kautsar
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Nukhba Zia
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Georgia J Michlig
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
| | - Abdulgafoor M Bachani
- Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street Suite E8527, Baltimore, MD, 21205, USA
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de Wet A, Pretorius C. From darkness to light: Barriers and facilitators to mental health recovery in the South African context. Int J Soc Psychiatry 2022; 68:82-89. [PMID: 33307927 DOI: 10.1177/0020764020981126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND South Africa is a low and middle income country facing many challenges in public mental health care and implementation of recovery. AIMS To contribute to what barriers and facilitators to recovery might be for service users in South Africa, from the perspective of service users, carers and service providers from three psychiatric hospitals in the Western Cape province. METHOD Interviews and focus groups were conducted with service users, carers and service providers. Interviews and focus groups were transcribed and analysed using atlas.ti software and reflexive thematic analysis, from the bottom up. RESULTS The barriers, environment, family, public mental health services, stigma and service users' attitude or behaviour generated, were found to be the most salient. The facilitators to recovery generated were support, family or friends, service providers, structure and empowerment. The need for support was identified as an underlying component to all these themes. CONCLUSION Barriers and facilitators to recovery seemed to have both intrapersonal and external sources that intersect at times. Recovery needs to be supported at an individual level, especially through an under-utilised resource such as peer support work, but in conjunction with the development of recovery-enabling environments in services and communities in South Africa.
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Affiliation(s)
- Anneliese de Wet
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
| | - Chrisma Pretorius
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
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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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Marais DL, Quayle M, Petersen I. Making consultation meaningful: Insights from a case study of the South African mental health policy consultation process. PLoS One 2020; 15:e0228281. [PMID: 31995612 PMCID: PMC6988953 DOI: 10.1371/journal.pone.0228281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/12/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND It is widely recognised that mental health policies should be developed in consultation with those tasked with their implementation and the users affected by them. In the South African legislative context public participation in policymaking is assumed, with little guidance on how to conduct consultation processes, nor how to use consultation inputs in policy decisions. METHODS The South African Mental Health Policy Framework and Strategic Plan was adopted in 2013 after an extensive consultation process. Focussing on the 2012 provincial and national consultation summit, this case-study conducted key informant interviews and undertook documentary analysis to explore the process through which consultation inputs were-or were not-transferred to inform this policy. Between 2013 and 2016 seven interviews were conducted, and 11 documents (policy drafts and summit outputs) and transcripts of 23 audio-recorded sessions from the national summit were analysed. RESULTS Findings revealed that no substantive changes were made to the mental health policy following the consultation summits. There do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs between provincial and national levels. There was also no further consultation regarding priorities identified for implementation prior to finalisation of the policy, with participants highlighting concerns about policy implementation at local levels as a result. This represents a lost opportunity for greater involvement of service users in policy development. CONCLUSIONS Together with poor service-user representation, the format of the consultation process limited participant interaction and the possibility for engagement with, or uptake of, more experiential forms of knowledge. Several procedural elements were found to limit the elicitation and transference of consultation contributions for uptake into policy. Recommendations for future policy consultations include adapting the format of participatory processes to enable optimal use of participant knowledge, as well as greater service-user participation.
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Affiliation(s)
- Debra Leigh Marais
- Undergraduate Research Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael Quayle
- Centre for Social Issues Research, Department of Psychology, University of Limerick, Limerick, Ireland
- Department of Psychology, School of Applied Human Sciences University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Bessoni E, Capistrano A, Silva G, Koosah J, Cruz K, Lucena M. Narrativas e sentidos do Programa de Volta para Casa: voltamos, e daí? SAUDE E SOCIEDADE 2019. [DOI: 10.1590/s0104-12902019190429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Este artigo apresenta e resume os principais achados em relação às repercussões do Programa de Volta para Casa nos territórios existenciais de seus beneficiários. Para isso, insere-se no bojo dos estudos internacionais e nacionais sobre o impacto das políticas públicas e avaliação do próprio beneficiário sobre elas. Dado o volume e a extensão dos dados, optou-se por apresentar análises a partir das narrativas construídas, elencando-se quatro aspectos: história de vida, autonomia, o que o dinheiro faz poder e relação com a rede de saúde. Considerando que os(as) participantes contam com anos ininterruptos de internação psiquiátrica, os achados evidenciaram um perfil de pessoas majoritariamente em situação de vulnerabilidade socioeconômica, com predominância de raça/cor negra e baixa escolaridade. O histórico de exclusão e negligência, portanto, teria contribuído para o adoecimento, reclusão e permanência em instituições fechadas. Pode-se afirmar que o Programa de Volta para Casa, associado à moradia, possibilitou a essas pessoas em processo de desinstitucionalização o aumento de poder contratual quanto ao cuidado de si, ao estabelecimento de relações afetivas, à circulação na cidade, ao consumo de bens e serviços e, consequentemente, maior capacidade de expressão, comunicação e posicionamento crítico. Foi possível observar novas esferas de negociação engendradas pelo recebimento do dinheiro.
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De Wet A, Parker J, Pretorius C. The Spring Foundation: a recovery approach to institutional public mental health services in South Africa. Perspect Public Health 2019; 139:123-124. [PMID: 31074345 DOI: 10.1177/1757913919838767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - John Parker
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa; Provincial Department of Health, Lentegeur Hospital, Cape Town, Western Cape Province, South Africa
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Burgess RA. Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting. Transcult Psychiatry 2016; 53:719-742. [PMID: 28317469 DOI: 10.1177/1363461516679056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Movement for Global Mental Health's (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women's narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.
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Affiliation(s)
- Rochelle Ann Burgess
- London Metropolitan University; University of Kwa-Zulu Natal; London School of Economics
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McVeigh J, MacLachlan M, Gilmore B, McClean C, Eide AH, Mannan H, Geiser P, Duttine A, Mji G, McAuliffe E, Sprunt B, Amin M, Normand C. Promoting good policy for leadership and governance of health related rehabilitation: a realist synthesis. Global Health 2016; 12:49. [PMID: 27558240 PMCID: PMC4997679 DOI: 10.1186/s12992-016-0182-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/01/2016] [Indexed: 11/26/2022] Open
Abstract
Background Good governance may result in strengthened performance of a health system. Coherent policies are essential for good health system governance. The overall aim of this research is to provide the best available scientific evidence on principles of good policy related leadership and governance of health related rehabilitation services in less resourced settings. This research was also conducted to support development of the World Health Organization’s (WHO) Guidelines on health related rehabilitation. Methods An innovative study design was used, comprising two methods: a systematic search and realist synthesis of literature, and a Delphi survey of expert stakeholders to refine and triangulate findings from the realist synthesis. In accordance with Pawson and Tilley’s approach to realist synthesis, we identified context mechanism outcome pattern configurations (CMOCs) from the literature. Subsequently, these CMOCs were developed into statements for the Delphi survey, whereby 18 expert stakeholders refined these statements to achieve consensus on recommendations for policy related governance of health related rehabilitation. Results Several broad principles emerged throughout formulation of recommendations: participation of persons with disabilities in policy processes to improve programme responsiveness, efficiency, effectiveness, and sustainability, and to strengthen service-user self-determination and satisfaction; collection of disaggregated disability statistics to support political momentum, decision-making of policymakers, evaluation, accountability, and equitable allocation of resources; explicit promotion in policies of access to services for all subgroups of persons with disabilities and service-users to support equitable and accessible services; robust inter-sectoral coordination to cultivate coherent mandates across governmental departments regarding service provision; and ‘institutionalizing’ programmes by aligning them with preexisting Ministerial models of healthcare to support programme sustainability. Conclusions Alongside national policymakers, our policy recommendations are relevant for several stakeholders, including service providers and service-users. This research aims to provide broad policy recommendations, rather than a strict formula, in acknowledgement of contextual diversity and complexity. Accordingly, our study proposes general principles regarding optimal policy related governance of health related rehabilitation in less resourced settings, which may be valuable across diverse health systems and contexts.
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Affiliation(s)
- Joanne McVeigh
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.,School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Malcolm MacLachlan
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland. .,School of Psychology, Trinity College Dublin, College Green, Dublin 2, Ireland. .,Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.
| | - Brynne Gilmore
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Chiedza McClean
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Arne H Eide
- Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa.,SINTEF Technology and Society, P.O. Box 124 Blindern, NO-0314, Oslo, Norway.,Department of Health Science, Norwegian University of Science and Technology, Tungasletta 2, 7047 Trondheim, Norway
| | - Hasheem Mannan
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Priscille Geiser
- Handicap International Fédération, 138, avenue des Frères Lumière, 69008, Lyon, France
| | - Antony Duttine
- Handicap International, 8757 Georgia Avenue, Suite 420, Silver Spring, MD 20910, USA
| | - Gubela Mji
- Centre for Rehabilitation Studies, Medicine and Health Sciences Faculty, Stellenbosch University, P.O. Box 241, Cape Town, 8000, South Africa
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Beth Sprunt
- Nossal Institute for Global Health, Level 4, Alan Gilbert Building, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010, Australia
| | - Mutamad Amin
- Ahfad University for Women, P.O. Box 167, Omdurman, Sudan
| | - Charles Normand
- Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Ireland.,Health Policy & Management, Trinity College Dublin, Room 0.21, 3-4 Foster Place, College Green, Dublin 2, Ireland
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Samudre S, Shidhaye R, Ahuja S, Nanda S, Khan A, Evans-Lacko S, Hanlon C. Service user involvement for mental health system strengthening in India: a qualitative study. BMC Psychiatry 2016; 16:269. [PMID: 27465387 PMCID: PMC4964288 DOI: 10.1186/s12888-016-0981-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 07/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is a wide recognition that involvement of service users and their caregivers in health system policy and planning processes can strengthen health systems; however, most evidence and experience has come from high-income countries. This study aimed to explore baseline experiences, barriers and facilitators to service user-caregiver involvement in the emerging mental health system in India, and stakeholders' perspectives on how greater involvement could be achieved. METHODS A qualitative study was conducted in Sehore district of Madhya Pradesh, India. In-depth interviews (n = 27) and a focus group discussion were conducted among service users, caregivers and their representatives at district, state and national levels and policy makers, service providers and mental health researchers. The topic guide explored the baseline situation in India, barriers and facilitators to service user and caregiver involvement in the following aspects of mental health systems: policy-making and planning, service development, monitoring and quality control, as well as research. Framework analysis was employed. RESULTS Respondents spoke of the limited involvement of service users and caregivers in the current Indian mental health system. The major reported barriers to this involvement were (1) unmet treatment and economic needs arising from low access to mental health services coupled with the high burden of illness, (2) pervasive stigmatising attitudes operating at the level of service user, caregiver, community, healthcare provider and healthcare administrators, and (3) entrenched power differentials between service providers and service users. Respondents prioritised greater involvement of service users in the planning of their own individual-level mental health care before considering involvement at the mental health system level. A stepwise progression was endorsed, starting from needs assessment, through empowerment and organization of service users and caregivers, leading finally to meaningful involvement. CONCLUSIONS Societal and system level barriers need to be addressed in order to facilitate the involvement of service users and caregivers to strengthen the Indian mental health system. Shifting from a largely 'provider-centric' to a more 'user-centric' model of mental health care may be a fundamental first step to sustainable user involvement at the system level.
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Affiliation(s)
- Sandesh Samudre
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India.
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
- The Public Health Foundation of India House No. 19, Rishi Nagar Char Imli, Bhopal, 462016, India.
| | - Rahul Shidhaye
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Shalini Ahuja
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Sharmishtha Nanda
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
| | - Azaz Khan
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
| | - Sara Evans-Lacko
- Center for Chronic Conditions and Injuries, The Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area Gurgaon, Delhi, NCR 122002, India
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
- London School of Economics and Political Science, Personal Social Services Research Unit, Houghton Street, London, WC2A 2AE, UK
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research Department, King's College London, PO29 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
- Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, 6th Floor, College of Health Sciences Building, Tikur Anbessa Hospital, PO 9086, Addis Ababa, Ethiopia
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Makan A, Fekadu A, Murhar V, Luitel N, Kathree T, Ssebunya J, Lund C. Stakeholder analysis of the Programme for Improving Mental health carE (PRIME): baseline findings. Int J Ment Health Syst 2015; 9:27. [PMID: 26155307 PMCID: PMC4493963 DOI: 10.1186/s13033-015-0020-z] [Citation(s) in RCA: 18] [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: 01/30/2015] [Accepted: 06/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The knowledge generated from evidence-based interventions in mental health systems research is seldom translated into policy and practice in low and middle-income countries (LMIC). Stakeholder analysis is a potentially useful tool in health policy and systems research to improve understanding of policy stakeholders and increase the likelihood of knowledge translation into policy and practice. The aim of this study was to conduct stakeholder analyses in the five countries participating in the Programme for Improving Mental health carE (PRIME); evaluate a template used for cross-country comparison of stakeholder analyses; and assess the utility of stakeholder analysis for future use in mental health policy and systems research in LMIC. METHODS Using an adapted stakeholder analysis instrument, PRIME country teams in Ethiopia, India, Nepal, South Africa and Uganda identified and characterised stakeholders in relation to the proposed action: scaling-up mental health services. Qualitative content analysis was conducted for stakeholder groups across countries, and a force field analysis was applied to the data. RESULTS Stakeholder analysis of PRIME has identified policy makers (WHO, Ministries of Health, non-health sector Ministries and Parliament), donors (DFID UK, DFID country offices and other donor agencies), mental health specialists, the media (national and district) and universities as the most powerful, and most supportive actors for scaling up mental health care in the respective PRIME countries. Force field analysis provided a means of evaluating cross-country stakeholder power and positions, particularly for prioritising potential stakeholder engagement in the programme. CONCLUSION Stakeholder analysis has been helpful as a research uptake management tool to identify targeted and acceptable strategies for stimulating the demand for research amongst knowledge users, including policymakers and practitioners. Implementing these strategies amongst stakeholders at a country level will hopefully reduce the knowledge gap between research and policy, and improve health system outcomes for the programme.
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Affiliation(s)
- Amit Makan
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town South Africa
| | - Abebaw Fekadu
- />Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia
- />Department of Psychological Medicine, King’s College London, Institute of Psychiatry, Centre for Affective Disorders and Affective Disorders Research Group, London, UK
| | - Vaibhav Murhar
- />Public Health Foundation of India, Sangath House, House Number 6, Rishi Nagar, Char Imli, Bhopal, 462016 Madhya Pradesh India
| | - Nagendra Luitel
- />Transcultural Psychosocial Organization Nepal, Baluwatar, Box 8974, Kathmandu, GPO Nepal
| | - Tasneem Kathree
- />School of Psychology, University of KwaZulu-Natal, Howard College Campus, Durban, 4000 South Africa
| | | | - Crick Lund
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 Cape Town South Africa
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Brooke-Sumner C, Lund C, Petersen I. Perceptions of psychosocial disability amongst psychiatric service users and caregivers in South Africa. Afr J Disabil 2014; 3:146. [PMID: 28730007 PMCID: PMC5443050 DOI: 10.4102/ajod.v3i1.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/19/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In many parts of South Africa there is little support for people with psychosocial disability caused by schizophrenia, beyond provision of psychotropic medications. Appropriate community-based psychosocial rehabilitation interventions are a crucial element of mental health service development. OBJECTIVES This study aimed to use an explanatory model of illness framework to document experiences of illness, disability and recovery amongst service users with schizophrenia and their caregivers in a poorly resourced area in the North West Province. Data were used to provide recommendations for a contextually appropriate non-specialist facilitated group psychosocial rehabilitation intervention. METHOD Eighteen in-depth individual interviews were conducted: nine with schizophrenia service users and nine with caregivers. Interviews were conducted by two trained field researchers; both clinical psychologists fluent in the first language of participants. All interviews were recorded, translated and transcribed. Data were thematically analysed using NVivo 9. RESULTS Participants linked the illness to witchcraft, poverty and stress. Family conflict was recognised in the course of the illness, causing stress and challenges for emotional well-being. Knowledge of diagnosis and biomedical treatment was minimal. Key factors recognised by service users as promoting recovery were the ability to work, and the support of traditional healers and religious structures. CONCLUSION Based on the findings of this study, a group psychosocial rehabilitation intervention emerged as a recommendation, with the incorporation of psycho-education, adherence support, coping skills, and opportunities for income generation and productive activity. The importance of also enlisting the support of religious leaders and traditional healers in supporting recovery is emphasised.
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Affiliation(s)
- Carrie Brooke-Sumner
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, South Africa
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Inge Petersen
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, South Africa
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Kleintjes S, Lund C, Swartz L. Barriers to the participation of people with psychosocial disability in mental health policy development in South Africa: a qualitative study of perspectives of policy makers, professionals, religious leaders and academics. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:17. [PMID: 23497079 PMCID: PMC3600028 DOI: 10.1186/1472-698x-13-17] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 02/27/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. METHOD Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people's organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. RESULTS Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. CONCLUSION A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development.
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Affiliation(s)
- Sharon Kleintjes
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Valkenberg Hospital, Observatory, Cape Town, 7935, South Africa.
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