scholarly journals Rural vs urban residence and experience of discrimination among people with severe mental illnesses in Ethiopia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sarah Forthal ◽  
Abebaw Fekadu ◽  
Girmay Medhin ◽  
Medhin Selamu ◽  
Graham Thornicroft ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Low Income ◽  
Rural Areas ◽  
Negative Binomial ◽  
Mental Illnesses ◽  
Urban Setting ◽  
Low Income Countries ◽  
Urban Settings ◽  
Adjusted Risk

Abstract Background Few studies have addressed mental illness-related discrimination in low-income countries, where the mental health treatment gap is highest. We aimed to evaluate the experience of discrimination among persons with severe mental illnesses (SMI) in Ethiopia, a low-income, rapidly urbanizing African country, and hypothesised that experienced discrimination would be higher among those living in a rural compared to an urban setting. Methods The study was a cross-sectional survey of a community-ascertained sample of people with SMI who underwent confirmatory diagnostic interview. Experienced discrimination was measured using the Discrimination and Stigma Scale (DISC-12). Zero-inflated negative binomial regression was used to estimate the effect of place of residence (rural vs. urban) on discrimination, adjusted for potential confounders. Results Of the 300 study participants, 63.3% had experienced discrimination in the previous year, most commonly being avoided or shunned because of mental illness (38.5%). Urban residents were significantly more likely to have experienced unfair treatment from friends (χ2(1) = 4.80; p = 0.028), the police (χ2(1) =11.97; p = 0.001), in keeping a job (χ2(1) = 5.43; p = 0.020), and in safety (χ2(1) = 5.00; p = 0.025), and had a significantly higher DISC-12 score than those living in rural areas (adjusted risk ratio: 1.66; 95% CI: 1.18, 2.33). Conclusions Persons with SMI living in urban settings report more experience of discrimination than their rural counterparts, which may reflect a downside of wider social opportunities in urban settings. Initiatives to expand access to mental health care should consider how social exclusion can be overcome in different settings.

scholarly journals Rural vs urban residence and experience of discrimination among people with severe mental illnesses in Ethiopia

2019 ◽  
Author(s):  
Sarah Forthal ◽  
Abebaw Fekadu ◽  
Girmay Medhin ◽  
Medhin Selamu ◽  
Graham Thornicroft ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Low Income ◽  
Rural Areas ◽  
Negative Binomial ◽  
Mental Illnesses ◽  
Urban Setting ◽  
Low Income Countries ◽  
Urban Settings ◽  
Adjusted Risk

Abstract Background Few studies have addressed mental illness-related discrimination in low-income countries, where the mental health treatment gap is highest. We aimed to evaluate the experience of discrimination among persons with severe mental illnesses (SMI) in Ethiopia, a low-income, rapidly urbanizing African country, and hypothesised that experienced discrimination would be higher among those living in a rural compared to an urban setting. Methods The study was a cross-sectional survey of a community-ascertained sample of people with SMI who underwent confirmatory diagnostic interview. Experienced discrimination was measured using the Discrimination and Stigma Scale (DISC-12). Zero-inflated negative binomial regression was used to estimate the effect of place of residence (rural vs. urban) on discrimination, adjusted for potential confounders. Results Of the 300 study participants, 63.3% had experienced discrimination in the previous year, most commonly being avoided or shunned because of mental illness (38.5%). Urban residents were significantly more likely to have experienced unfair treatment from friends (χ2(1)=4.80; p=0.028), the police (χ2(1) =11.97; p=0.001), in keeping a job (χ2(1)=5.43; p=0.020), and in safety (χ2(1)=5.00; p=0.025), and had a significantly higher DISC-12 score than those living in rural areas (adjusted risk ratio: 1.66; 95% CI: 1.18, 2.33). Conclusions Persons with SMI living in urban settings report more experience of discrimination than their rural counterparts, which may reflect a downside of wider social opportunities in urban settings. Initiatives to expand access to mental health care should consider how social exclusion can be overcome in different settings.

scholarly journals Rural vs urban residence and experience of discrimination among people with severe mental illnesses in Ethiopia

2019 ◽  
Author(s):  
Sarah Forthal ◽  
Abebaw Fekadu ◽  
Girmay Medhin ◽  
Medhin Selamu ◽  
Graham Thornicroft ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Low Income ◽  
Rural Areas ◽  
Negative Binomial ◽  
Mental Illnesses ◽  
Low Income Countries ◽  
Cross Sectional Survey ◽  
Urban Settings ◽  
Adjusted Risk

Abstract Background Few studies have addressed mental illness-related discrimination in low-income countries, where the mental health treatment gap is highest. We aimed to evaluate the experience of discrimination among persons with severe mental illnesses (SMI) in Ethiopia, a low-income, rapidly urbanizing African country, and hypothesised that experienced discrimination would be higher among those living in a rural compared to an urban setting.Methods The study was a cross-sectional survey of a community-ascertained sample of people with SMI who underwent confirmatory diagnostic interview. Experienced discrimination was measured using the Discrimination and Stigma Scale (DISC-12). Zero-inflated negative binomial regression was used to estimate the effect of place of residence (rural vs. urban) on discrimination, adjusted for potential confounders.Results Of the 300 study participants, 63.3% had experienced discrimination in the previous year, most commonly being avoided or shunned because of mental illness (38.5%). Urban residents were significantly more likely to have experienced unfair treatment from friends (χ2(1)=4.80; p=0.028), the police (χ2(1) =11.97; p=0.001), in keeping a job (χ2(1)=5.43; p=0.020), and in safety (χ2(1)=5.00; p=0.025), and had a significantly higher DISC-12 score than those living in rural areas (adjusted risk ratio: 1.66; 95% CI: 1.18, 2.33).Conclusions Persons with SMI living in urban settings report more experience of discrimination than their rural counterparts, which may reflect a downside of wider social opportunities in urban settings. Initiatives to expand access to mental health care should consider how social exclusion can be overcome in different settings.

scholarly journals Stigma and discrimination limit access to mental health care

2008 ◽  
Vol 17 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Graham Thornicroft
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Low Income ◽  
Help Seeking ◽  
Mental Illnesses ◽  
Low Income Countries ◽  
Stigma And Discrimination ◽  
Epidemiological Surveys

AbstractThis editorial provides an overview of how far access to mental health care is limited by perceptions of stigma and anticipated discrimination. Globally over 70% of young people and adults with mental illness receive no treatment from healthcare staff. The rates of non-treatment are far higher in low income countries. Evidence from some descriptive studies and epidemiological surveys suggest that potent factors increasing the likelihood of treatment avoidance, or long delays before presenting for care include: (i) lack of knowledge about the features and treatability of mental illnesses; (ii) ignorance about how to access assessment and treatment; (iii) prejudice against people who have mental illness, and (iv) expectations of discrimination against people who have a diagnosis of mental illness. The associations between low rates of help seeking, and stigma and discrimination are as yet poorly understood and require more careful characterisation and analysis, providing the platform for more effective action to ensure that a greater proportion of people with mental illness are effectively treated in future.

scholarly journals Treatment Engagement of Psychotic Patients with a Mobile Mental Health Unit in Rural Areas in Greece: A Five-Year Study

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Vaios Peritogiannis ◽  
Athina Tatsioni ◽  
Nefeli Menti ◽  
Aikaterini Grammeniati ◽  
Vassiliki Fotopoulou ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Low Income ◽  
Rural Areas ◽  
Psychotic Disorders ◽  
Low Income Countries ◽  
Community Mental Health Service ◽  
Health Unit ◽  
Mobile Mental Health ◽  
Mental Health Unit

Objectives. Treatment of psychotic disorders is impended by high rates of disengagement from mental health services and poor adherence to antipsychotic medication. This study examined the engagement rates of psychotic patients with a community mental health service during a 5-year period.Methods. The Mobile Mental Health Unit of Ioannina and Thesprotia (MMHU I-T) delivers services in remote, rural, mountainous areas using the resources of the primary care system. Clinical and demographic information for patients with a diagnosis of schizophrenia and related psychoses was obtained from the medical records of our unit.Results. A total of 74 psychotic patients initially engaged in treatment with our unit. In half of cases treatment was home-based. With the exclusion of patients who died or discharged, engagement rates were 67.2%. Statistical analysis was performed for 64 patients, and no differences were found between engaged and disengaged patients regarding clinical and demographic parameters. All engaged patients regularly refilled their antipsychotic prescriptions.Conclusion. Engagement rates in our study were comparable to previous research, involving urban settings and shorter follow-up duration. Community mental health teams may ensure treatment continuation for psychotic patients in deprived, remote areas. This is important for low-income countries, affected by economic crisis, such as Greece.

Social determinants in low-income countries

2018 ◽  
pp. 177-180
Author(s):  
Syed Masud Ahmed ◽  
Mohammad Didar Hossain
Keyword(s):  
Mental Health ◽  
Social Determinants ◽  
Low Income ◽  
Partner Violence ◽  
Common Mental Disorders ◽  
Public Health Problem ◽  
Complex Problem ◽  
Mental Illnesses ◽  
Low Income Countries ◽  
Important Public Health Problem

Mental health disorders are increasingly being recognized as an important public health problem in low-income countries of Asia and Africa. For people of low-income countries, poverty is all pervasive and affects physical, as well as mental, health in various ways. Common mental disorders (CMD), such as anxiety and depression, are quite common among these populations. Social determinants—such as poverty and exclusion; low level of education; violence against women, including intimate partner violence; unemployment; unhygienic living and work environment; and social capital—play a significant role in precipitating CMD at different stages of life. The association is not always straightforward as sometimes these determinants act in a vicious circle (e.g. poverty and mental illnesses), which, in turn, is exacerbated by other determinants such as low education and unemployment. To address this complex problem, tackling of these important social determinants is essential and should be prioritized.

scholarly journals The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990–2013

2017 ◽  
Vol 41 (S1) ◽  
pp. S156-S157 ◽  
Author(s):  
R. Charara ◽  
A. Mokdad
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Disorders ◽  
Low Income ◽  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Eastern Mediterranean Region ◽  
Low Income Countries ◽  
Years Of Life Lost ◽  
Life Years

The eastern Mediterranean region (EMR) is witnessing an increase in mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the global burden of disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of total disease burden in EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years. The highest proportion of DALYs occurred in the 25–49 age group. The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Depressive disorders accounted for most DALYs, followed by anxiety disorders. Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to global level. Our findings call for EMR health ministries to increase provision of mental health services and to address stigma of mental illness. Our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability.

scholarly journals Prevalence and Associated Factors of Metabolic Syndrome among Patients with Severe Mental Illness Attending a Tertiary Hospital in Southwest Uganda

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
David Collins Agaba ◽  
Richard Migisha ◽  
Rosemary Namayanja ◽  
Godfrey Katamba ◽  
Henry Mark Lugobe ◽  
...  
Keyword(s):  
Mental Health ◽  
Metabolic Syndrome ◽  
Mental Illness ◽  
Logistic Regression ◽  
Severe Mental Illness ◽  
Low Income ◽  
Associated Factors ◽  
Tertiary Hospital ◽  
Low Income Countries ◽  
Health Clinic

Globally, the prevalence of metabolic syndrome (MetS) and its components which are the major cardiovascular disease (CVD) risk factors, is higher among patients with severe mental illness (SMI) compared to the general population. This is mainly due to the deleterious lifestyles characterized by physical inactivity, excessive alcohol consumption, smoking, and unhealthy diets common among patients with SMI as well as due to cardiometabolic effects of psychotropic medications. Despite these conditions being highly prevalent among patients with SMI, little attention is given to these conditions during routine reviews in the mental health clinics in most low-income countries including Uganda. The main objective of this study was to determine the prevalence and associated factors of MetS among patients with SMI at Mbarara Regional Referral Hospital (MRRH), a tertiary hospital in southwestern Uganda. Through a cross-sectional study at the mental health clinic of the hospital, we recruited 304 patients with SMI and evaluated them for MetS using the National Cholesterol Education Programme Adult Treatment Panel III (NCEP ATP III) criteria. We defined the prevalence of MetS as the proportion of patients meeting the NCEP ATP III criteria. We used logistic regression to evaluate associations between MetS and independent variables. We included a total of 302 (44.37% male, 55.63% female) patients with a diagnosis of SMI in the analysis. The prevalence of MetS was 23.51% (95% CI 18.84–28.71). At multivariable logistic regression, age >40 years and long duration of mental illness (>10 years) were significantly associated with MetS. The prevalence of MetS is high among patients with psychiatric disorders, and thus metabolic screening, especially among the high-risk groups, is critical.

scholarly journals Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic multicentre randomised controlled trial (UPSIDES-RCT)

2020 ◽  
Author(s):  
Galia Sharon Moran ◽  
Jasmine Kalha ◽  
Annabel Mueller-Stierlin ◽  
Reinhold Kilian ◽  
Silvia Krumm ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Cost Effectiveness ◽  
Peer Support ◽  
Low Income ◽  
Social Inclusion ◽  
Controlled Trial ◽  
Low Income Countries ◽  
Service Users ◽  
Randomised Controlled

Abstract Background: Peer support is an established intervention involving a person recovering from mental illness to support others with mental illness.. Peers are an under-used resource in global mental health. Building upon comprehensive formative research, this study will rigorously evaluate the impact of peer support at multiple levels, including: service user outcomes (psychosocial and clinical); peer support worker outcomes (work role, empowerment); service outcomes (cost-effectiveness, return on investment); and implementation outcomes (adoption, sustainability, organisational change). Methods: UPSIDES-RCT is a pragmatic parallel-group multi-centre randomised controlled trial assessing the effectiveness of UPSIDES at four measurement points over one year (baseline, 4-, 8-, and 12-month follow-up), with embedded process evaluation and cost-effectiveness analysis. Research will take place in a range of high-, middle- and low-income countries (Germany, United Kingdom, Israel, India, Uganda, Tanzania). The primary outcome is social inclusion of service users with severe mental illness (N= 558; N = 93 per site) at 8-month follow-up, measured with the Social Inclusion Scale. Secondary outcomes include empowerment (Empowerment Scale), hope (HOPE scale), recovery (Stages of Recovery), and health and social functioning (Health of the Nations Outcome Scales). Mixed-methods process evaluation will investigate mediators and moderators of effect, and implementation experiences of four UPSIDES stakeholder groups (service users, peer support workers, mental health workers, policy makers). A cost-effectiveness analysis examining cost-utility and health budget impact will estimate the value for money of UPSIDES peer support. Discussion: The UPSIDES-RCT will explore the essential components necessary to create a peer support model in mental health care, while providing the evidence required to sustain and eventually scale-up the intervention in different cultural, organisational and resource settings. By actively involving and empowering service users, UPSIDES will move mental health systems toward a recovery orientation, emphasising user-centeredness, community participation, and the realisation of mental health as a human right.

scholarly journals Perceived Stigma Towards Mental Illness and Its Associated Factors among Community People of Pokhara Metropolitan, Kaski, Nepal

2020 ◽  
Vol 10 (2) ◽  
pp. 28-35
Author(s):  
Biddhya Bhattarai ◽  
Jenny Ojha
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Low Income ◽  
Associated Factors ◽  
Mental Health Problems ◽  
Public Health Problem ◽  
World Health ◽  
Low Income Countries ◽  
Perceived Stigma ◽  
Community People

Introduction: Mental illness is a major and neglected public health problem. People suffering from mental health problems are among the foremost stigmatized, discriminated, marginalized, disadvantaged and vulnerable members of our society. According to the World Health Organization, 450 million people are suffering from mental illness worldwide and around 80% of them live in middle and low-income countries. In spite of the high burden of mental disorders, globally, around 70% of people with mental illness do not receive any treatment, and evidence suggests that stigma plays a major role in treatment avoidance. The objective of this study is to assess the level of perceived stigma towards mental illness and its associated factors among community people of Pokhara Metropolitan. Methods: A community based descriptive cross-sectional study was conducted among the people of Pokhara Metropolitan. Systematic random sampling was employed for the selection of 292 participants. Face to face interview was conducted for the data collection using Community Attitude Towards Mental Illness (CAMI) scale. Chi square test was used to find the association between variables and stigma towards mental illness on different subscales of CAMI scale. Results: The overall prevalence of stigma towards mental illness was 72.9%. The prevalence of stigma was high under all the four domains of CAMI scale. Age, education, occupation and income were significantly associated with stigma score in all domains. Marital status had significant association to authoritarian as well as social restrictiveness domains score. However, sex and family history of mental illness was associated with Benevolence and community mental health ideology score respectively. Conclusion: The findings of the study depicted that stigma towards mental illness is high among the community people in all four subscales of CAMI scale. The study has revealed the stigma towards mental illness is  influenced by the various socio-demographic and socioeconomic factors. This study suggested that there is strong need to eliminate the stigma associated with mental illness to improve the mental health status of the region.

Prescriptive Power: Biologism, Biopsychiatry and Drug-centred Psychopharmacology

Somatechnics ◽  
2019 ◽  
Vol 9 (2-3) ◽  
pp. 291-309
Author(s):  
Francis Russell
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Social Justice ◽  
Cultural Theory ◽  
Human Experience ◽  
Mental Illnesses ◽  
False Consciousness ◽  
The Subject ◽  
Biological Ontology ◽  
Health Discourse

This paper looks to make a contribution to the critical project of psychiatrist Joanna Moncrieff, by elucidating her account of ‘drug-centred’ psychiatry, and its relation to critical and cultural theory. Moncrieff's ‘drug-centred’ approach to psychiatry challenges the dominant view of mental illness, and psychopharmacology, as necessitating a strictly biological ontology. Against the mainstream view that mental illnesses have biological causes, and that medications like ‘anti-depressants’ target specific biological abnormalities, Moncrieff looks to connect pharmacotherapy for mental illness to human experience, and to issues of social justice and emancipation. However, Moncrieff's project is complicated by her framing of psychopharmacological politics in classical Marxist notions of ideology and false consciousness. Accordingly, she articulates a political project that would open up psychiatry to the subjugated knowledge of mental health sufferers, whilst also characterising those sufferers as beholden to ideology, and as being effectively without knowledge. Accordingly, in order to contribute to Moncrieff's project, and to help introduce her work to a broader humanities readership, this paper elucidates her account of ‘drug-centred psychiatry’, whilst also connecting her critique of biopsychiatry to notions of biologism, biopolitics, and bio-citizenship. This is done in order to re-describe the subject of mental health discourse, so as to better reveal their capacities and agency. As a result, this paper contends that, once reframed, Moncrieff's work helps us to see value in attending to human experience when considering pharmacotherapy for mental illness.

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