scholarly journals Building resilient families: Developing family interventions for preventing adolescent depression and HIV in low resource settings

2018 ◽  
Vol 56 (1) ◽  
pp. 187-212 ◽  
Author(s):  
Caroline Kuo ◽  
Ashleigh LoVette ◽  
Dan J. Stein ◽  
Lucie D. Cluver ◽  
Larry K. Brown ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Adolescent Depression ◽  
Developmentally Appropriate ◽  
Family Intervention ◽  
Hiv And Aids ◽  
Family Interactions ◽  
Middle Income ◽  
Family Approach ◽  
Family Meetings

Depression contributes significantly to the global burden of disease in low- and middle-income countries. In South Africa, individuals may be at elevated risk for depression due to HIV and AIDS, violence, and poverty. For adolescents, resilience-focused prevention strategies have the potential to reduce onset of depression. Involving families in promoting adolescent mental health is developmentally appropriate, but few existing interventions take a family approach to prevention of adolescent depression. We conducted a qualitative investigation from 2013–2015 to inform the development of a family intervention to prevent adolescent depression in South Africa among families infected or at risk for HIV. Using focus groups with adolescents and parents (eight groups, n = 57), and interviews (n = 25) with clinicians, researchers, and others providing mental health and related services, we identified context-specific factors related to risk for family depression, and explored family interactions around mental health more broadly as well as depression specifically. Findings indicate that HIV and poverty are important risk factors for depression. Future interventions must address linguistic complexities in describing and discussing depression, and engage with the social interpretations and meanings placed upon depression in the South African context, including bewitchment and deviations from prescribed social roles. Participants identified family meetings as a context-appropriate prevention strategy. Family meetings offer opportunities to practice family problem solving, involve other family members in communal parenting during periods of parental depression, and serve as forums for building Xhosa-specific interpretations of resilience. This study will guide the development of Our Family Our Future, a resilience-focused family intervention to prevent adolescent depression (ClinicalTrials.gov #NCT02432352).

Health service costs and their association with functional impairment among adults receiving integrated mental health care in five low- and middle-income countries: the PRIME cohort study

2020 ◽  
Vol 35 (5) ◽  
pp. 567-576 ◽  
Author(s):  
Dan Chisholm ◽  
Emily Garman ◽  
Erica Breuer ◽  
Abebaw Fekadu ◽  
Charlotte Hanlon ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Health Care ◽  
Cohort Study ◽  
Health Service ◽  
Mental Health Care ◽  
Functional Impairment ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Service Costs

Abstract This study examines the level and distribution of service costs—and their association with functional impairment at baseline and over time—for persons with mental disorder receiving integrated primary mental health care. The study was conducted over a 12-month follow-up period in five low- and middle-income countries participating in the Programme for Improving Mental health carE study (Ethiopia, India, Nepal, South Africa and Uganda). Data were drawn from a multi-country intervention cohort study, made up of adults identified by primary care providers as having alcohol use disorders, depression, psychosis and, in the three low-income countries, epilepsy. Health service, travel and time costs, including any out-of-pocket (OOP) expenditures by households, were calculated (in US dollars for the year 2015) and assessed at baseline as well as prospectively using linear regression for their association with functional impairment. Cohort samples were characterized by low levels of educational attainment (Ethiopia and Uganda) and/or high levels of unemployment (Nepal, South Africa and Uganda). Total health service costs per case for the 3 months preceding baseline assessment averaged more than US$20 in South Africa, $10 in Nepal and US$3–7 in Ethiopia, India and Uganda; OOP expenditures ranged from $2 per case in India to $16 in Ethiopia. Higher service costs and OOP expenditure were found to be associated with greater functional impairment in all five sites, but differences only reached statistical significance in Ethiopia and India for service costs and India and Uganda for OOP expenditure. At the 12-month assessment, following initiation of treatment, service costs and OOP expenditure were found to be lower in Ethiopia, South Africa and Uganda, but higher in India and Nepal. There was a pattern of greater reduction in service costs and OOP spending for those whose functional status had improved in all five sites, but this was only statistically significant in Nepal.

Relationship Enhancement® as an Intervention to Facilitate Rehabilitation of Persons with Severe Mental Illness

1997 ◽  
Vol 28 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Michael P. Accordino ◽  
James T. Herbert
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Workers ◽  
Family Intervention ◽  
Mental Health Workers ◽  
Rehabilitation Counselors ◽  
Family Interactions ◽  
Relationship Enhancement ◽  
Behavioral Family Intervention ◽  
Skill Building

Relationship Enhancement® (RE) is an effective approach to improve family interactions. RE is a behavioral family intervention with a psychoeducational approach that emphasizes skill building rather than symptom reduction. This article describes RE and how it may be particularly useful in facilitating rehabilitation efforts for families who have a member with serious mental illness (SMI). Mental health workers and rehabilitation counselors who intervene on a family systems level may find this approach particularly helpful.

scholarly journals The Secret History method and the development of an ethos of care: Preparing the maternity environment for integrating mental health care in South Africa

2019 ◽  
Vol 57 (1) ◽  
pp. 173-182 ◽  
Author(s):  
Simone Honikman ◽  
Sally Field ◽  
Sara Cooper
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Health Care ◽  
Task Shifting ◽  
Care Providers ◽  
Middle Income ◽  
Pedagogical Intervention ◽  
Middle Income Countries ◽  
Health Project ◽  
Secret History

South Africa, like many low-and-middle-income countries, is integrating mental health services into routine Primary Health Care (PHC) through a task-shifting approach to reduce the gaps in treatment coverage. There is concern, however, that this approach will exacerbate nurses’ abuse of patients currently common within PHC in the country. To address this concern, the Perinatal Mental Health Project developed its Secret History method, a critical pedagogical intervention for care-providers working within maternity settings. This article describes the method’s theoretical underpinnings and practical application amongst nurses. Drawing on Augusto Boal’s Theatre of the Oppressed and contrary to traditional nursing training in South Africa, the method creates a space for nurses to interrogate and reimagine nurse–patient relations. By introducing nurses to a counter ideology of empathic care, the method seeks to prepare the maternity environment for mental health task-shifting initiatives and ensure these initiatives are more democratic, responsive and humane.

Systematic review of the evidence base for treatment of common mental disorders in South Africa

2017 ◽  
Vol 48 (1) ◽  
pp. 32-47 ◽  
Author(s):  
Debra Kaminer ◽  
Michael Owen ◽  
Byron Schwartz
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Mental Disorders ◽  
South African ◽  
Common Mental Disorders ◽  
Evidence Base ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mental Health Interventions ◽  
Low And Middle Income

The scarcity of mental health resources in low- and middle-income countries requires the identification of effective interventions that can be taken to scale in a cost-efficient manner. Yet the evidence base for treatment of common mental disorders in low- and middle-income countries remains limited. As one of the better resourced countries on the African continent, South Africa could potentially play a leading role in developing an African evidence base for mental health care. This study sought to describe and evaluate the South African evidence base for treating common mental disorders. A systematic review of randomised controlled trials for depression, substance use, and anxiety in the adult South African population from 2000 to mid-2015 was conducted. Eligible studies were assessed for their consistency with recommendations for mental health interventions in low- and middle-income countries and for methodological and reporting rigour. A total of 16 RCTs satisfied the inclusion criteria, of which 8 targeted depression, 6 targeted substance use, and 2 targeted anxiety symptoms. There has been a strong trend towards alignment with prevailing recommendations for delivery of mental health interventions in resource-scarce regions. While there are some promising findings with regard to effectiveness of specific interventions, replication, costing, and dissemination studies are still required and there is still an urgent need for treatment studies for anxiety disorders, which are the most common class of common mental disorder in South Africa. The review also indicates that research design and reporting practices in South African mental health intervention research could be enhanced and recommendations towards this are suggested.

Inclusion of people with psychosocial disability in low and middle income contexts: a practice review

2017 ◽  
Vol 4 (3) ◽  
pp. 72-81 ◽  
Author(s):  
Helen Lea Fernandes ◽  
Stephanie Cantrill ◽  
Raj Kamal ◽  
Ram Lal Shrestha
Keyword(s):  
Mental Health ◽  
Local Community ◽  
Global Mental Health ◽  
Economic Life ◽  
Health Programs ◽  
Middle Income ◽  
Psychosocial Disability ◽  
Practice Review ◽  
Mental Health Programs ◽  
Low And Middle Income

Much of the literature about mental illness in low and middle income countries (LMICs) focuses on prevalence rates, the treatment gap, and scaling up access to medical expertise and treatment. As a cause and consequence of this, global mental health programs have focused heavily on service delivery without due exploration of how programs fit into a broader picture of culture and community. There is a need for research which highlights approaches to broader inclusion, considering historical, cultural, social, and economic life contexts and recognises the community as a determinant of mental health — in prevention, recovery, resilience, and support of holistic wellness. The purpose of this practice review is to explore the experiences of three local organisations working with people with psychosocial disability living in LMICs: Afghanistan, India, and Nepal. All three organisations have a wealth of experience in implementing mental health programs, and the review brings together evidence of this experience from interviews, reports, and evaluations. Learnings from these organisations highlight both successful approaches to strengthening inclusion and the challenges faced by people with psychosocial disability, their families, and communities.  The findings can largely be summarised in two categories, although both are very much intertwined: first, a broad advocacy, public health, and policy approach to inclusion; and second, more local, community-based initiatives. The evidence draws attention to the need to acknowledge the complexities surrounding mental health and inclusion, such as additional stigmatisation due to multidimensional poverty, gender inequality, security issues, natural disasters, and additional stressors associated with access. Organisational experiences also highlight the need to work with communities’ strengths to increase capacity around inclusion and to apply community development approaches where space is created for communities to generate holistic solutions. Most significantly, approaches at all levels require efforts to ensure that people with psychosocial disability are given a voice and are included in shaping programs, policies, and appropriate responses.

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