Rehabilitation for Persons with Severe Mental Illness in Lower- and Middle-Income Countries

2019 ◽  
pp. 1-14
Author(s):  
Jagadisha Thirthalli ◽  
Thanapal Sivakumar ◽  
Chethan Basavarajappa
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals Exploration of recovery of people living with severe mental illness (SMI) in low/middle-income countries (LMICs): a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045005
Author(s):  
Fadia Gamieldien ◽  
Roshan Galvaan ◽  
Bronwyn Myers ◽  
Zarina Syed ◽  
Katherine Sorsdahl
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Scoping Review ◽  
Data Extraction ◽  
Flow Diagram ◽  
Personal Recovery ◽  
Middle Income ◽  
Middle Income Countries ◽  
Provider Perspectives ◽  
Low Middle Income Countries

ObjectiveTo examine the literature on how recovery of people with severe mental illness (SMI) is conceptualised in low/middle-income countries (LMICs), and in particular what factors are thought to facilitate recovery.DesignScoping review.Data sources and eligibilityWe searched 14 electronic databases, hand searched citations and consulted with experts during the period May–December 2019. Eligible studies were independently screened for inclusion and exclusion by two reviewers. Unresolved discrepancies were referred to a third reviewer.Data extraction and synthesisAll bibliographical data and study characteristics were extracted using a data charting form. Selected studies were analysed through a thematic analysis emerging from extracted data.ResultsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram offers a summary of the results: 4201 titles, 1530 abstracts and 109 full-text articles were screened. Ten articles were selected for inclusion: two from Turkey, two from India, and one each from China, Swaziland, Indonesia, Egypt, South Africa and Vietnam. Although most studies used qualitative methods, data collection and sampling methods were heterogeneous. One study reported on service provider perspectives while the rest provided perspectives from a combination of service users and caregivers. Three themes emerged from the data analysis. First, studies frame recovery as a personal journey occurring along a continuum. Second, there was an emphasis on social relationships as a facilitator of recovery. Third, spirituality emerged as both a facilitator and an indicator of recovery. These themes were not mutually exclusive and some overlap exists.ConclusionAlthough there were commonalities with how high-income countries describe recovery, we also found differences in conceptualisation. These differences in how recovery was understood reflect the importance of framing the personal recovery concept in relation to local needs and contextual issues found in LMICs. This review highlighted the current sparse evidence base and the need to better understand recovery from SMI in LMICs.

scholarly journals Homelessness and severe mental illness in low- and middle-income countries: scoping review

BJPsych Open ◽  
2019 ◽  
Vol 5 (4) ◽  
Author(s):  
Caroline Smartt ◽  
Martin Prince ◽  
Souci Frissa ◽  
Julian Eaton ◽  
Abebaw Fekadu ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Scoping Review ◽  
Homeless People ◽  
Middle Income ◽  
Middle Income Countries ◽  
Manual Search ◽  
Cultural Responses ◽  
Key Aspects ◽  
Low And Middle Income

Background Despite being a global problem, little is known about the relationship between severe mental illness (SMI) and homelessness in low- and middle-income countries (LMICs). Homeless people with SMI are an especially vulnerable population and face myriad health and social problems. In LMICs, low rates of treatment for mental illness, as well as differing family support systems and cultural responses to mental illness, may affect the causes and consequences of homelessness in people with SMI. Aims To conduct a systematic, scoping review addressing the question: what is known about the co-occurrence of homelessness and SMI among adults living in LMICs? Method We conducted an electronic search, a manual search and we consulted with experts. Two reviewers screened titles and abstracts, assessed publications for eligibility and appraised study quality. Results Of the 49 included publications, quality was generally low: they were characterised by poor or unclear methodology and reporting of results. A total of 7 publications presented the prevalence of SMI among homeless people; 12 presented the prevalence of homelessness among those with SMI. Only five publications described interventions for this population; only one included an evaluation component. Conclusions Evidence shows an association between homelessness and SMI in LMICs, however there is little information on the complex relationship and direction of causality between the phenomena. Existing programmes should undergo rigorous evaluation to identify key aspects required for individuals to achieve sustainable recovery. Respect for human rights should be paramount when conducting research with this population. Declaration of interest None.

scholarly journals Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries

2016 ◽  
Vol 26 (4) ◽  
pp. 348-354 ◽  
Author(s):  
C. Hanlon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Human Rights ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Mental Health Professionals ◽  
Task Sharing ◽  
Middle Income ◽  
Middle Income Countries

The explicit inclusion of mental health within the Sustainable Development Goals is a welcome development, borne out of powerful advocacy using public health, economic and human rights arguments. As funding comes on line for scale-up of evidence-based mental health care by task-sharing with primary care, it is time to take stock about care for people affected by severe mental illness (SMI). The existing evidence base for task shared care for SMI provides an imperative to get started, but is skewed towards relatively more affluent and urban populations in middle-income countries where specialist mental health professionals provide most of the care. Randomised, controlled trials and rigorous implementation research on task shared service models are underway which will go some way to improving understanding of the quality, safety, effectiveness and acceptability of more widely generalisable care for people with SMI. A sub-group of people with SMI have more complex and long-term needs for care, with a high risk of homelessness, imprisonment and human rights violations as family and social supports become overwhelmed. Case studies from non-governmental organisations provide examples of holistic approaches to rehabilitation, recovery and empowerment of people with SMI, but rigorous comparative studies are needed to identify the most efficient, effective and scalable approaches to care. Health system constraints are emerging as the over-riding barriers to successful task-sharing, highlighting a need to develop and evaluate chronic care models for people with SMI that succeed in reducing premature mortality, improving wellbeing and achieving better social outcomes. Addressing these evidence gaps is essential if task-sharing mental health care is going to deliver on its promise of promoting recovery for the full range of people affected by SMI.

Informal mental health interventions for people with severe mental illness in low and lower middle-income countries: A systematic review of effectiveness

2019 ◽  
Vol 65 (3) ◽  
pp. 194-206 ◽  
Author(s):  
Trang Nguyen ◽  
Sara Holton ◽  
Thach Tran ◽  
Jane Fisher
Keyword(s):  
Systematic Review ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Community Care ◽  
Cochrane Central Register ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Informal Community ◽  
The Impact

Background: The effectiveness of interventions for people with severe mental illness delivered by informal community care providers in low and lower middle-income countries is not known. The aim was to conduct a systematic review of the impact of community-based interventions implemented by the informal sector for people with severe mental illness in these settings. Methods: Five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials) were searched for English-language publications using both keywords and MeSH terms. All study designs were included. Results: Five papers, reporting data from five studies conducted in four low and lower middle-income countries in 2017, met the inclusion criteria for the review. Of the five included studies, three had a before and after design, one was a randomized controlled trial, and one a qualitative investigation. Most interventions with a low-moderate quality of evidence used informal community care providers to deliver either self-help groups, traditional healing treatments, and/or a rehabilitation program. The investigators reported data about improvements in the outcomes of intervention participants (psychosocial functioning, psychotic symptoms, and social inclusion) and positive impacts on their families (family’s knowledge and skills of mental illness management, caregiving burden, social exclusion/stigma against people with severe mental illness, and financial burden). Cost-effectiveness of the intervention (in one study) found that it had a higher financial cost but greater effectiveness than the usual standard of care. Conclusion: Although only a small number of studies were identified, the review provides promising evidence of the professionally developed interventions for people with severe mental illness, delivered by the informal community workforce in low and lower middle-income settings. Training and supportive supervision for informal community care providers are crucial components of effective interventions.

scholarly journals Cancer and severe mental illness in low‐ and middle‐income countries: The challenges and outlook for the future

2021 ◽  
Author(s):  
Sung Jin Park ◽  
Alisa Wai ◽  
Keechilat Pavithran ◽  
Beena Kunheri ◽  
Koravangattu Valsraj
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Future ◽  
Low And Middle Income

scholarly journals Exploration of recovery of people living with severe mental illness (SMI) in low-income and middle-income countries (LMIC): a scoping review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e032912 ◽  
Author(s):  
Fadia Gamieldien ◽  
Roshan Galvaan ◽  
Bronwyn Myers ◽  
Katherine Sorsdahl
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Latin American ◽  
Scoping Review ◽  
Low Income ◽  
Qualitative Content Analysis ◽  
Grey Literature ◽  
Mental Health Policy ◽  
Middle Income ◽  
Middle Income Countries

IntroductionThe construct of recovery was conceptualised in high-income countries and its applicability in low-income and middle- income countries is underexplored. A scoping review is proposed to synthesise knowledge, review conceptual overlap and map key elements of recovery from severe mental illness in low-income and middle-income countries. We aim to appraise the literature so as to inform future recovery-oriented services that consider the cultural and contextual influences on recovery from severe mental illness.Methods and analysisThe following electronic databases: MEDLINE via PubMed, SCOPUS (which included contents of Embase), PsycINFO, CINAHL, Africa-Wide Information, PsycARTICLES, Health source: Nursing/Academic Edition, Academic Search Premier and SocINDEX all via the EBSCOHOST platform, the Latin American and Caribbean Health Sciences Literature, the Cochrane Centre Register of Controlled Trials) and grey literature sources will be searched between May and December 2019. Eligible studies will be independently screened for inclusion and exclusion by two reviewers using a checklist developed for this purpose. Studies published between January 1993 and November 2019 that focus on recovery from severe mental illness in a low-income and middle-income country will be included. Findings will be compared and discrepancies will be discussed. Unresolved discrepancies will be referred to a third reviewer. All bibliographic data and study characteristics will be extracted and thematically analysed using a tool developed through an iterative process by the research team. Indicators will be classified according to a predefined conceptual framework and categorised and described using qualitative content analysis.Ethics and disseminationThe review aims to synthesise information from available publications, hence it does not require ethical approval. The results will be disseminated through publications, conference presentations and future workshops with stakeholders involved within the recovery paradigm of mental health policy and practice. The scoping review title is registered with the Joanna Briggs Institute.

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