scholarly journals Scaling up mental healthcare in the Republic of Niger: priorities for and barriers to service improvement

2015 ◽  
Vol 12 (S1) ◽  
pp. S-6-S-9
Author(s):  
Alison Hwong ◽  
Djibo Maiga Douma ◽  
Soumana Zamo ◽  
Julian Eaton
Keyword(s):  
Mental Health ◽  
Health Workers ◽  
Health Centre ◽  
National Level ◽  
Scale Up ◽  
Mental Healthcare ◽  
Traditional Healers ◽  
World Health ◽  
Service Improvement ◽  
Local Health

As part of a pilot programme to scale up community mental health services, local health centre directors, community health workers and key informants were interviewed in two neighbouring political districts of Niger. Major priorities for improving services included training staff on the diagnosis and treatment of mental illness, collaborating with traditional healers, educating the community about the origins of psychiatric illness and building infrastructure for medication delivery. Barriers to care included long distances for travel to the nearest hospital and lack of funding for home-based visits by health workers. This study was the first step in Niger's plan to implement the World Health Organization's Mental Health Gap Action Programme (mhGAP) at a national level.

scholarly journals Implementation of the new WHO recommendations on HIV and infant feeding: Challenges and the way forward

2012 ◽  
Vol 12 (52) ◽  
pp. 6274-6290
Author(s):  
C Sagoe-Moses ◽  
◽  
K Mwinga ◽  
P Habimana ◽  
ID Toure ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Health Workers ◽  
National Level ◽  
Scale Up ◽  
World Health ◽  
Child Health Services ◽  
Feeding Practice ◽  
Policy Makers ◽  
Hiv Exposed ◽  
The Way

Breast milk provides all the nutrient needs of the infant especially in the first six months of life and also protects the growing infant from pneumonia, diarrhoea, and malnutrition, which are the major causes of morbidity and mortality in the African Region. However breastfeeding is also known to transmit the Human Immunodeficiency Virus (HIV) from mother to the child. Several guidelines have been developed to guide policy makers, health workers and mothers on the most appropriate methods to feed HIV exposed infants. Previous HIV and infant feeding guidelines emphasized on preventing infants from becoming infected with HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over the period, programme implementers and researchers have reported difficulties in implementing earlier recommendations and guidelines on HIV and infant feeding within health-care systems. New evidence now shows that giving Anti-Retroviral therapy (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding. Thus, in 2010 World Health Organization (WHO) issued the latest guidelines on HIV and infant feeding entitled Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. The 2010 WHO guidelines have changed the recommendations on how HIV infected mothers should feed their infants, and how health workers should support them. National authorities in each country can decide which infant feeding practice will be primarily promoted and supported by Maternal and Child Health services, i.e. breastfeeding with an antiretroviral intervention to reduce transmission or avoidance of all breastfeeding. Previous guidelines and recommendations on infant feeding in the context of HIV have undergone frequent changes over the past decade. The adaptation and implementation of previous and current guidelines at national level have met challenges. These include lack of consensus among key stakeholders, inadequate funding for the additional cost of providing ARVs to the mother or the child and difficulties in communicating the recommendations in the new guidelines clearly to mothers, health workers and policy makers. To address these challenges a number of proposals have been suggested such as coordinated consensus building process, costing of interventions and a phased implementation approach to ensure successful scale up over time. This paper describes the process of adapting global HIV and infant feeding recommendations and guidelines at national level. It also reviews the challenges encountered in implementation and proposes the way forward in addressing them.

scholarly journals Delivering maternal mental health through peer volunteers: a 5-year report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Najia Atif ◽  
Amina Bibi ◽  
Anum Nisar ◽  
Shaffaq Zulfiqar ◽  
Ikhlaq Ahmed ◽  
...  
Keyword(s):  
Mental Health ◽  
Financial Incentives ◽  
Health Workers ◽  
Maternal Mental Health ◽  
Scale Up ◽  
Psychosocial Interventions ◽  
World Health ◽  
Research Attention ◽  
Peer Volunteers

Abstract Background Maternal depression affects one in five women in low-and middle income countries (LMIC) and has significant economic and social impacts. Evidence-based psychosocial interventions delivered by non-specialist health workers are recommended as first-line management of the condition, and recent studies on such interventions from LMIC show promising results. However, lack of human resource to deliver the interventions is a major bottle-neck to scale-up, and much research attention has been devoted to ‘task-sharing’ initiatives. A peer-delivered version of the World Health Organization’s Thinking Healthy Programme for perinatal depression in Pakistan and India showed clinical, functional and social benefits to women at 3 months postpartum. The programme has been iteratively adapted and continually delivered for 5 years in Pakistan. In this report, we describe the extended intervention and factors contributing to the peers’ continued motivation and retention, and suggest future directions to address scale-up challenges. Methods The study was conducted in rural Rawalpindi. We used mixed methods to evaluate the programme 5 years since its initiation. The competency of the peers in delivering the intervention was evaluated using a specially developed Quality and Competency Checklist, an observational tool used by trainers to rate a group session on key areas of competencies. In-depth interviews explored factors contributing to the peer volunteers’ continued motivation and retention, as well as the key challenges faced. Results Our key findings are that about 70% of the peer volunteers inducted 5 years ago continued to be part of the programme, retaining their competency in delivering the intervention, with only token financial incentives. Factors contributing to sustained motivation included altruistic aspirations, enhanced social standing in the community, personal benefits to their own mental health, and the possibility for other avenues of employment. Long-term challenges included demotivation due to lack of certainty about the programme’s future, increased requirement for financial incentivisation, the logistics of organising groups in the community, and resistance from some families to the need for ongoing care. Conclusions The programme, given the sustained motivation and competence of peer volunteers in delivering the intervention, has the potential for long-term sustainability in under-resourced settings and a candidate for scale-up.

scholarly journals Attitudes towards mental illness in Uganda: a survey in 18 districts

2007 ◽  
Vol 4 (1) ◽  
pp. 19-21 ◽  
Author(s):  
Vuokko Wallace ◽  
Jed Boardman ◽  
James Walsh
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Workers ◽  
Mental Healthcare ◽  
Traditional Healers ◽  
Capital City ◽  
Sub Saharan Africa ◽  
Psychiatric Nurses ◽  
Poor Access ◽  
Sub Saharan

Uganda, in common with many countries in sub-Saharan Africa, has many population risk factors predictive of high levels of mental disorder but poor coverage of mental healthcare (Kigozi, 2005). Recent population studies conducted in Uganda have shown rates of disorder in excess of 20% (Kasoro et al, 2002; Bolton et al, 2004; Ovuga et al, 2005) and the survey by Kasoro et al (2002) showed a high prevalence of patients with severe mental illness and poor access to services. There are 19 psychiatrists for 24.8 million people in Uganda, all but one of whom is based in the capital city, Kampala (Kigozi, 2005). The provision of mental health services relies on the use of psychiatric clinical officers (a cadre of trained mental health workers, similar to community psychiatric nurses, who currently cover 18 of the 56 districts in Uganda), primary care personnel, non-governmental organisations and members of the community. Liaison with traditional healers is encouraged (Ovuga et al, 1999).

scholarly journals Service Characteristics and Geographical Variation in Compulsory Hospitalisation: An Exploratory Random Effects Within–Between Analysis of Norwegian Municipalities, 2015–2018

2021 ◽  
Vol 12 ◽  
Author(s):  
Tore Hofstad ◽  
Jorun Rugkåsa ◽  
Solveig Osborg Ose ◽  
Olav Nyttingnes ◽  
Solveig Helene Høymork Kjus ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
General Practitioners ◽  
Random Effects ◽  
Geographical Variation ◽  
Health Workers ◽  
Health Centre ◽  
Mental Healthcare ◽  
Service Characteristics ◽  
Catchment Areas

Background: Compulsory hospitalisation in mental healthcare is contested. For ethical and legal reasons, it should only be used as a last resort. Geographical variation could indicate that some areas employ compulsory hospitalisation more frequently than is strictly necessary. Explaining variation in compulsory hospitalisation might contribute to reducing overuse, but research on associations with service characteristics remains patchy.Objectives: We aimed to investigate the associations between the levels of compulsory hospitalisation and the characteristics of primary mental health services in Norway between 2015 and 2018 and the amount of variance explained by groups of explanatory variables.Methods: We applied random-effects within–between Poisson regression of 461 municipalities/city districts, nested within 72 community mental health centre catchment areas (N = 1,828 municipality-years).Results: More general practitioners, mental health nurses, and the total labour-years in municipal mental health and addiction services per population are associated with lower levels of compulsory hospitalisations within the same areas, as measured by both persons (inpatients) and events (hospitalisations). Areas that, on average, have more general practitioners and public housing per population have lower levels of compulsory hospitalisation, while higher levels of compulsory hospitalisation are seen in areas with a longer history of supported employment and the systematic gathering of service users' experiences. In combination, all the variables, including the control variables, could account for 39–40% of the variation, with 5–6% related to municipal health services.Conclusion: Strengthening primary mental healthcare by increasing the number of general practitioners and mental health workers can reduce the use of compulsory hospitalisation and improve the quality of health services.

scholarly journals Experience of implementing new mental health indicators within information systems in six low- and middle-income countries

BJPsych Open ◽  
2019 ◽  
Vol 5 (5) ◽  
Author(s):  
Shalini Ahuja ◽  
Charlotte Hanlon ◽  
Dan Chisholm ◽  
Maya Semrau ◽  
Dristy Gurung ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Information Systems ◽  
Health Workers ◽  
Scale Up ◽  
Mental Healthcare ◽  
Health Indicators ◽  
Health Data ◽  
Care Staff ◽  
African Countries

BackgroundSuccessful scale-up of integrated primary mental healthcare requires routine monitoring of key programme performance indicators. A consensus set of mental health indicators has been proposed but evidence on their use in routine settings is lacking.AimsTo assess the acceptability, feasibility, perceived costs and sustainability of implementing indicators relating to integrated mental health service coverage in six South Asian (India, Nepal) and sub-Saharan African countries (Ethiopia, Nigeria, South Africa, Uganda).MethodA qualitative study using semi-structured key informant interviews (n= 128) was conducted. The ‘Performance of Routine Information Systems’ framework served as the basis for a coding framework covering three main categories related to the performance of new tools introduced to collect data on mental health indicators: (1) technical; (2) organisation; and (3) behavioural determinants.ResultsMost mental health indicators were deemed relevant and potentially useful for improving care, and therefore acceptable to end users. Exceptions were indicators on functionality, cost and severity. The simplicity of the data-capturing formats contributed to the feasibility of using forms to generate data on mental health indicators. Health workers reported increasing confidence in their capacity to record the mental health data and minimal additional cost to initiate mental health reporting. However, overstretched primary care staff and the time-consuming reporting process affected perceived sustainability.ConclusionsUse of the newly developed, contextually appropriate mental health indicators in health facilities providing primary care services was seen largely to be feasible in the six Emerald countries, mainly because of the simplicity of the forms and continued support in the design and implementation stage. However, approaches to implementation of new forms generating data on mental health indicators need to be customised to the specific health system context of different countries. Further work is needed to identify ways to utilise mental health data to monitor and improve the quality of mental health services.Declaration of interestNone.

The EPA Guidance Project: Guidance for Mental Healthcare in Europe

2015 ◽  
Vol 12 (01) ◽  
pp. 5-11
Author(s):  
I. Großimlinghaus ◽  
J. Zielasek ◽  
W. Gaebel
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Graduate Training ◽  
Action Plan ◽  
Stakeholder Involvement ◽  
Mental Healthcare ◽  
World Health ◽  
Post Graduate Training ◽  
Health Organization

Summary Background: The development of guidelines is an important and common method to assure and improve quality in mental healthcare in European countries. While guidelines have to fulfill predefined criteria such as methodological accuracy of evidence retrieval and assessment, and stakeholder involvement, the development of guidance was not standardized yet. Aim: In 2008, the European Psychiatric Association (EPA) initiated the EPA Guidance project in order to provide guidance in the field of European psychiatry and related fields for topics that are not dealt with by guideline developers – for instance due to lack of evidence or lack of funding. The first three series of EPA Guidance deal with diverse topics that are relevant to European mental healthcare, such as quality assurance for mental health services, post-graduate training in mental healthcare, trust in mental health services and mental health promotion. Results: EPA Guidance recommendations address current and future challenges for European psychiatry. They are developed in accordance with the World Health Organization (WHO) European Mental Health Action Plan.

scholarly journals Improving access to mental healthcare for displaced Syrians: case studies from Syria, Iraq and Turkey

2016 ◽  
Vol 13 (4) ◽  
pp. 84-86 ◽  
Author(s):  
P. Hughes ◽  
Z. Hijazi ◽  
K. Saeed
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Primary Healthcare ◽  
Unmet Need ◽  
Mental Healthcare ◽  
Integrated Approach ◽  
World Health ◽  
Case Examples ◽  
Displaced People

The conflict in Syria has led to an unprecedented humanitarian crisis that extends across multiple countries in the area. Mental health services were undeveloped before and now face huge strain and unmet need. The World Health Organization and others have developed a programme to build capacity in the delivery of mental health services in an integrated healthcare package to refugees and displaced people. The tool used for this is the mhGAP Intervention Guide and complementary materials. In this paper we refer to training in Turkey, Iraq and Syria where health professionals were trained to roll out this community-based integrated approach through primary healthcare. We describe field case examples that show the complexity of situations that face refugees, displaced people and those caught in active conflict. Training improved the knowledge and skills for managing mental health disorders in primary healthcare. Further work needs to be done to demonstrate greater access to and utilisation of services, client outcomes and organisational change with this approach.

Global psychiatry

2017 ◽  
pp. 674-680
Author(s):  
Paul Harrison ◽  
Philip Cowen ◽  
Tom Burns ◽  
Mina Fazel
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Workers ◽  
Global Mental Health ◽  
Scale Up ◽  
Mental Health Workers ◽  
Middle Income ◽  
Humanitarian Emergencies ◽  
Psychiatric Illnesses ◽  
Aids Pandemic

‘Global psychiatry’ discusses the global mental health movement. Across the globe, and especially in low- and middle-income settings, there is a high prevalence of untreated psychiatric illness. In lower resourced settings there is often the need to address the added influence of poverty. The chapter discusses the question of how to scale up services and models, including using lay mental health workers and also integration of mental health care into primary health care settings to better meet the needs of those suffering from psychiatric illnesses across the globe. Four areas are discussed in more detail—the HIV/AIDS pandemic, perinatal mental illness, child and adolescent mental health, and humanitarian emergencies.

scholarly journals Development of a psychological first-aid model in inpatients with COVID-19 in Wuhan, China

2020 ◽  
Vol 33 (3) ◽  
pp. e100292 ◽  
Author(s):  
Wenhong Cheng ◽  
Fang Zhang ◽  
Yingqi Hua ◽  
Zhi Yang ◽  
Jun Liu
Keyword(s):  
Mental Health ◽  
Health Workers ◽  
Psychological Intervention ◽  
Mental Healthcare ◽  
First Aid ◽  
Mental Health Workers ◽  
Psychological Interventions ◽  
Medical Systems ◽  
Psychological First Aid ◽  
Face To Face

BackgroundFacing the social panic and substantial shortage of medical resources during the coronavirus disease 2019 (COVID-19) outbreak, providing psychological first-aid to inpatients is essential for their rehabilitation and the orderly operating of medical systems. However, the closed-ward environment and extreme shortage of onsite mental health workers have limited the use of traditional face-to-face diagnosis and psychological interventions.AimTo develop a mental health intervention model for inpatients that can be applied during a widespread epidemic, such as COVID-19.MethodsIn a medical team stationed in Leishenshan Hospital, Wuhan, China, we integrated onsite and online psychological support resources to implement a graded psychological intervention system. The onsite psychiatrist established trust with the patients and classified them into categories according to their symptom severity. While face-to-face evaluation and intervention are critical for effective online support, the online team effectively extended the scope of the ‘first-aid’ to all patients.ConclusionThis integrated onsite and online approach was effective and efficient in providing psychological interventions for inpatients during the crisis. Our model provides a realistic scheme for healthcare systems in or after the COVID-19 epidemic and also could be adopted in areas of the world with insufficient mental healthcare resources.

scholarly journals Training in psychiatry in less developed countries

1989 ◽  
Vol 13 (10) ◽  
pp. 558-560 ◽  
Author(s):  
Neil L. Holden
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Physical Health ◽  
Health Resources ◽  
Developed Countries ◽  
Traditional Healers ◽  
World Health ◽  
Less Developed Countries ◽  
Year 2000 ◽  
Developed World

The declared aim of the World Health Organization, based on the Alma Ata declaration (1978), is to promote health care for all by the year 2000. It is recognised that this can be achieved only by the channelling of efforts into the development of primary health care, with medical care greatly augmented by the utilisation of non-medical carers, traditional healers and public health measures. As in more developed countries, where psychiatry struggles to maintain its share of national health resources against the ever increasing demand of technical advances in physical health care, so the mental health services of the less developed countries constantly are in danger of losing out to physical health in the battle against illness and natural disasters. To redress this balance and to meet the needs for mental health by the year 2000, the less developed world needs more psychiatrists (who are currently estimated to relate to the population at a rate of approximately only one per million) and these psychiatrists need to be appropriately trained to meet the challenges. How can the more developed nations help in this training of trainees from the less developed world? Can a partnership be formed between nations that ensures that trainees in psychiatry, in whichever country, are equipped as well as possible for the needs of their home country?

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