scholarly journals Health System Governance for the Integration of Mental Health Services into Primary Health Care in the Sub-Saharan Africa and South Asia Region: A Systematic Review

2021 ◽  
Vol 58 ◽  
pp. 004695802110285
Author(s):  
Arifah Abd Rahim ◽  
Rosliza Abdul Manaf ◽  
Muhammad Hanafiah Juni ◽  
Normala Ibrahim
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
South Asia ◽  
Mental Healthcare ◽  
Sub Saharan Africa ◽  
Human Resource Capacity ◽  
Sub Saharan

Governance has been highlighted as an important building block underpinning the process of mental health integration into primary healthcare. This qualitative systematic review aims to identify the governance issues faced by countries in the Sub-Saharan Africa and South Asia Region in the implementation of integrated primary mental healthcare. PRISMA guideline was used to conduct a systematic search of relevant studies from 4 online databases that were filtered according to inclusion and exclusion criteria. Using the Critical Appraisal Skills Program (CASP) Qualitative Checklist, a quality appraisal of the selected articles was performed. By drawing upon institutional theory, data was extracted based on a pre-constructed matrix. The CERQual approach synthesized evidence and rank confidence level as low, moderate or high for 5 key findings. From 567 references identified, a total of 8 studies were included. Respondents were policymakers or implementers involved in integrated primary mental healthcare from the national, state, and district level. Overall, the main governance issues identified were a lack of leadership and mental health prioritization; inadequate financing and human resource capacity; and negative mental health perceptions/attitudes. The implication of the findings is that such issues must be addressed for long-term health system performance. This can also improve policymaking for better integration of primary mental health services into the health systems of countries in the Sub-Saharan and South Asia region.

scholarly journals Readiness to Deliver Person-Focused Care in A Fragile Situation: The Case of Mental Health Services in Lebanon

2020 ◽  
Author(s):  
Aya Noubani ◽  
Karin Diaconu ◽  
Giulia Loffreda ◽  
Shadi Saleh
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Health Care Providers ◽  
Mental Healthcare ◽  
Care Providers ◽  
Health Seeking

Abstract Background: Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support (MHPSS) service provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model.Methods: A qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon. Results: Findings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one’s livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon’s populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient’s experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care.Conclusion: Mental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to 1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and 2) promote the implementation of integrated person focused care for addressing mental health.

scholarly journals Management of mental health services in Malawi

2008 ◽  
Vol 5 (2) ◽  
pp. 29-30 ◽  
Author(s):  
Felix Kauye
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Gross Domestic Product ◽  
Sub Saharan Africa ◽  
Gdp Per Capita ◽  
Domestic Product ◽  
Per Capita ◽  
Sub Saharan

Malawi is a country in sub-Saharan Africa bordering Mozambique, Tanzania and Zambia. It has an area of approximately 118000 km2 and is divided into northern, central and southern regions. It has an estimated population of 13 million, 47% of whom are under 15 years of age and just 5% over 60 years. Its economy is largely based on agriculture, with tobacco being the main export. The projected growth in gross domestic product (GDP) for 2007 was 8.8%; GDP per capita was $284 per annum.

Toward the integration of comprehensive mental health services in HIV care: An assessment of psychiatric morbidity among HIV-positive individuals in sub-Saharan Africa

AIDS Care ◽  
2013 ◽  
Vol 25 (9) ◽  
pp. 1193-1198 ◽  
Author(s):  
Andrew T. Olagunju ◽  
Olasimbo A. Ogundipe ◽  
Adebayo R. Erinfolami ◽  
Abiola A. Akinbode ◽  
Joseph D. Adeyemi
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Morbidity ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Hiv Positive ◽  
Sub Saharan

scholarly journals Readiness to deliver person‐focused care in a fragile situation: the case of Mental Health Services in Lebanon

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Aya Noubani ◽  
Karin Diaconu ◽  
Giulia Loffreda ◽  
Shadi Saleh
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Health Care Providers ◽  
Mental Healthcare ◽  
Care Providers ◽  
Health Seeking

Abstract Background Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support service (MHPSS) provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model. Methods A qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon. Results Findings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one’s livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon’s populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient’s experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care. Conclusions Mental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to (1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and (2) promote the implementation of integrated person focused care for addressing mental health.

scholarly journals The mental health impact of the COVID-19 pandemic: Implications for sub-Saharan Africa.

2020 ◽  
Author(s):  
Souci Frissa ◽  
Bazghina-werq Semo Dessalegn
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Stress Disorders ◽  
Sub Saharan Africa ◽  
Post Traumatic Stress ◽  
Care Workers ◽  
Traumatic Stress Disorders ◽  
Sub Saharan

The COVID-19 pandemic is leading to mental health problems due to disease experience, physical distancing, stigma and discrimination, and job losses in many of the settings hardest hit by the pandemic. Health care workers, patients with COVID-19 and other illnesses, children, women, youth, and the elderly are experiencing post-traumatic stress disorders, anxiety, depression, and insomnia. Virtual mental health services have been established in many settings and social media is being used to impart mental health education and communication resources. This rapid review highlights mental health services across countries hardest hit by the COVID-19 pandemic. More needs to be done to take these services to scale and ensure equity and efficiency.The impact of COVID-19 on mental health in sub-Saharan Africa could be immense, given the weak health care systems. Similar to the Ebola epidemic of 2014-2016, COVID-19 is expected to cause anxiety, depression and post-traumatic stress disorders. Uptake of mental health care services is generally low, and communities rely on social resources. Hence, efforts to control the disease transmission should be contextualized. Low digital literacy, low smartphone penetration and limited internet connection make online mental health services a limited option for service delivery. Safeguarding social and cultural resilience factors and coping mechanisms is critical in the sub-Saharan African context. Mass media is a feasible way of providing social resources. Community health workers can be trained quickly to provide mental health education, screening and counselling services. Toll-free mental health helplines can be used to provide services to health care workers and those needing customized care. Mental health and psychosocial support services need to be integrated into the pandemic response and coordinated nationally. It is critical for these services to continue during and after the epidemic.

Depression, pregnancy, and HIV: the case to strengthen mental health services for pregnant and post-partum women in sub-Saharan Africa

2014 ◽  
Vol 1 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Elizabeth M Stringer ◽  
Samantha Meltzer-Brody ◽  
Margaret Kasaro ◽  
Alison M Stuebe ◽  
Samantha Wiegand ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Post Partum ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Depression: International intervention for a global problem

2004 ◽  
Vol 184 (5) ◽  
pp. 379-380 ◽  
Author(s):  
Mike. J. Crawford
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
World Health Organization ◽  
Sub Saharan Africa ◽  
World Health ◽  
The World ◽  
Health Related ◽  
Sub Saharan ◽  
Health Organization

Since 1948 the World Health Organization has had the challenging task of trying to achieve ‘the attainment by all peoples of the highest possible level of health’ (World Health Organization, 1946). A central part of this work has involved assessing the extent of health-related problems in different parts of the world and advocating for the implementation of effective strategies to address these problems. For many years the World Health Organization has expressed concerns about the relatively low level of funding assigned to mental health services in many countries. Estimates based on data collected in 2000 show that in most of sub-Saharan Africa and South-East Asia there are fewer than one mental health nurse and one psychiatrist per 100 000 people (World Health Organization, 2001). Two papers produced with the support of the World Health Organization and published in this issue of the Journal strengthen the argument for additional funding for mental health services. In the first paper, üstün and colleagues (2004, this issue) summarise data on the relative impact of common health-related problems in different regions of the world, and in an accompanying paper Chisholm and others (2004, this issue) estimate the cost-effectiveness of different interventions for depression in these different areas.

scholarly journals HIV Case Management Support Service Is Associated with Improved CD4 Counts of Patients Receiving Care at the Antiretroviral Clinic of Pantang Hospital, Ghana

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Bismark Sarfo ◽  
Naa Ashiley Vanderpuye ◽  
Abigail Addison ◽  
Peter Nyasulu
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Case Management ◽  
Support Services ◽  
Support Service ◽  
Sub Saharan Africa ◽  
Management Support ◽  
Cd4 Counts ◽  
Sub Saharan

Background. Factors associated with individual patient-level management of HIV have received minimal attention in sub-Saharan Africa. This study determined the association between support services and cluster of differentiation 4 (CD4) counts among HIV patients attending ART clinic in Ghana. Methodology. This was a cross-sectional study involving adults with HIV recruited between 1 August 2014 and 31 January 2015. Data on support services were obtained through a closed-ended personal interview while the CD4 counts data were collected from their medical records. Data were entered into EpiData and analyzed using Stata software. Results. Of the 201 patients who participated in the study, 67% (129/191) received case management support service. Counseling about how to prevent the spread of HIV (crude odds ratio (cOR) (95% confidence interval (CI)) (2.79 (1.17–6.68)), mental health services (0.2 (0.04–1.00)), and case management support service (2.80 (1.34–5.82))) was associated with improved CD4 counts of 350 cells/mm3 or more. After adjusting for counseling about how to prevent the spread of HIV and mental health services, case management support service was significantly associated with CD4 counts of 350 cells/mm3 or more (aOR = 2.36 (CI = 1.01–5.49)). Conclusion. Case management support service for HIV patients receiving ART improves their CD4 counts above 350 cells/mm3. Incorporating HIV case management services in ART regimen should be a priority in sub-Saharan Africa.

scholarly journals Adapting practice in mental healthcare settings during the COVID-19 pandemic and other contagions: systematic review

BJPsych Open ◽  
2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Jessica Raphael ◽  
Rachel Winter ◽  
Katherine Berry
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mental Health Services ◽  
Health Services ◽  
Infection Control ◽  
Mental Healthcare ◽  
Well Being ◽  
Healthcare Services ◽  
Control Measures ◽  
Infection Control Measures

Background During the global COVID-19 pandemic, there has been guidance concerning adaptations that physical healthcare services can implement to aid containment, but there is relatively little guidance for how mental healthcare services should adapt service provision to better support staff and patients, and minimise contagion spread. Aims This systematic review explores service adaptations in mental health services during the COVID-19 pandemic and other contagions. Method The Allied and Complementary Medicine database (AMED), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Medline, PsycINFO and Web of Science were systematically searched for published studies from database inception to April 2020. Data were extracted focusing on changes to mental health services during contagion outbreaks. Data were analysed with thematic analysis. Results Nineteen papers were included: six correspondence/point-of-view papers, five research papers, five reflection papers, two healthcare guideline documents and one government document. Analysis highlighted four main areas for mental health services to consider during contagion outbreaks: infection control measures to minimise contagion spread, including procedural and practical solutions across different mental health settings; service delivery, including service changes, operational planning and continuity of care; staff well-being (psychological and practical support); and information and communication. Conclusions Mental health services need to consider infection control measures and implement service changes to support continuity of care, and patient and staff well-being. Services also need to ensure they are communicating important information in a clear and accessible manner with their staff and patients, regarding service delivery, contagion symptoms, government guidelines and well-being.

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