A Local Perspective: Experiences And Handling of Mental Health Burden During The COVID-19 Pandemic In Uganda.

Abstract BackgroundThe COVID-19 pandemic has increased the prevalence of mental health illness around the world. While research has espoused these realities from the context of western countries, however, similar evidence from low income countries like Uganda is still missing. This is despite the fact that scholars have pointed out that given inadequate funding, health facilities and personnel to treat people with mental health challenges, the impact of the COVID-19 pandemic could be severe. Further, it is still unclear how locals in low income countries like Uganda manage to cope with mental health challenges given the lack of adequate skilled response, especially during a pandemic that has increased the pressure on the healthcare system. Therefore, this study aims to fill this gap by investigating local people’s experience and handling of mental health burden during the COVID-19 pandemic n Uganda. Methods Qualitative primary data was collected from Uganda in November and December 2020. The sample selection involved a two-staged cluster sampling technique via the AfriSight online platform. Our study included a total of 1249 participants picked from the 4 different regions of Uganda. On the basis of this, thematic analysis was used to analyze the data. Results Our study revealed that the COVID-19 pandemic and its associated interventions contributed to the increasing mental health burden in Uganda. The four most pronounced forms of mental health illnesses included stress, anxiety, depression and traumatic disorders with the leading causes being closure of income-generating activities, fear of dying, sexual and domestic abuse. While a few people had access to skilled mantel health care, the majority of the people struggled to access this form of care. Skilled maternal care remained an attractive yet unattainable form of care for many. Thus, most people relied on various forms of local strategies that were feasible. ConclusionOur study revealed that Uganda was home to various local survival strategies that counter the inadequacies presented by the weak health care system. Particularly, a culture of reciprocity, family and community network forms important coping avenues for many left stranded by the lack of adequate skilled care. Thus, in the context of Uganda during the COVID-19 pandemic, it seemed more logical to promote scaling up feasibly and locally-available solutions rather than idealistically focusing on attractive yet unattainable forms of care.

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Immigration and Contract Problems Experienced by Foreign-Educated Nurses

Medical Care Research and Review ◽

10.1177/1077558711432890 ◽

2012 ◽

Vol 69 (3) ◽

pp. 351-365 ◽

Cited By ~ 8

Author(s):

Patricia Pittman ◽

Carolina Herrera ◽

Joanne Spetz ◽

Catherine R. Davis

Keyword(s):

United States ◽

Health Care ◽

Low Income ◽

The United States ◽

Low Income Countries ◽

Labor Rights ◽

Care Practice ◽

Quality Health Care ◽

International Recruitment ◽

The Impact

More than 8% of employed RNs licensed since 2004 in the United States were educated overseas, yet little is known about the conditions of their recruitment or the impact of that experience on health care practice. This study assessed whether the labor rights of foreign-educated nurses were at risk during the latest period of high international recruitment: 2003 to 2007. Using consensus-based standards contained in the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Health Professionals to the United States, this study found 50% of actively recruited foreign-educated nurses experienced a negative recruitment practice. The study also found that nurses educated in low-income countries and nurses with high contract breach fees, were significantly more likely to report such problems. If, as experts believe may occur, the nursing shortage in the United States returns around 2014, oversight of international recruitment will become critically important to delivering high-quality health care to Americans.

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Food insecurity among people with severe mental disorder in a rural Ethiopian setting: a comparative, population-based study

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796017000701 ◽

2017 ◽

Vol 28 (04) ◽

pp. 397-407 ◽

Cited By ~ 9

Author(s):

K. Tirfessa ◽

C. Lund ◽

G. Medhin ◽

Y. Hailemichael ◽

A. Fekadu ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Food Insecurity ◽

Low Income ◽

World Health ◽

Household Food Insecurity ◽

Household Food ◽

Food Insecurity Access ◽

The Impact

Aim.In low-income African countries, ensuring food security for all segments of the population is a high priority. Mental illness is associated consistently with poverty, but there is little evidence regarding the association with food insecurity. The aim of this study was to compare the levels of food insecurity in people with severe mental disorders (SMD) with the general population in a rural African setting with a high burden of food insecurity.Method.Households of 292 community-ascertained people with a specialist-confirmed diagnosis of SMD (including schizophrenia and bipolar disorder) were compared with 284 households without a person with SMD in a rural district in south Ethiopia. At the time of the study, no mental health services were available within the district. Food insecurity was measured using a validated version of the Household Food Insecurity Access Scale. Disability was measured using the World Health Organisation Disability Assessment Schedule 2.0.Result.Severe household food insecurity was reported by 32.5% of people with SMD and 15.9% of respondents from comparison households: adjusted odds ratio 2.82 (95% confidence interval 1.62 to 4.91). Higher annual income was associated independently with lower odds of severe food insecurity. When total disability scores were added into the model, the association between SMD and food insecurity became non-significant, indicating a possible mediating role of disability.Conclusion.Efforts to alleviate food insecurity need to target people with SMD as a vulnerable group. Addressing the disabling effects of SMD would also be expected to reduce food insecurity. Access to mental health care integrated into primary care is being expanded in this district as part of the Programme for Improving Mental health carE (PRIME). The impact of treatment on disability and food insecurity will be evaluated.

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Integration of mental health care into primary care

The British Journal of Psychiatry ◽

10.1192/bjp.176.6.581 ◽

2000 ◽

Vol 176 (6) ◽

pp. 581-588 ◽

Cited By ~ 101

Author(s):

D. Chisholm ◽

S. James ◽

K. Sekar ◽

K. Kishore Kumar ◽

R. Srinivasa Murthy ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Primary Care ◽

Health Care ◽

Mental Disorder ◽

Mental Health Care ◽

Low Income ◽

Common Mental Disorder ◽

Low Income Countries

BackgroundTargeting resources on cost-effective care strategies is important for the global mental health burden.AimsTo demonstrate cost–outcome methods in the evaluation of mental health care programmes in low-income countries.MethodFour rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use.ResultsBetween 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced.ConclusionEconomic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.

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Stigma and discrimination limit access to mental health care

Epidemiologia e Psichiatria Sociale ◽

10.1017/s1121189x00002621 ◽

2008 ◽

Vol 17 (1) ◽

pp. 14-19 ◽

Cited By ~ 165

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.

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The multiplier role of psychiatrists in low income settings

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796014000080 ◽

2014 ◽

Vol 23 (2) ◽

pp. 123-127 ◽

Cited By ~ 10

Author(s):

F. Kigozi ◽

J. Ssebunnya

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Mental Health Professionals ◽

Low Income ◽

Health Workers ◽

Developed Countries ◽

Low Income Countries ◽

Wide Range

Mental health care is receiving increased attention in low-income countries with the availability of a wide range of effective evidence-based treatments for acute and chronic mental disorders amidst scarce resources. Availability of these treatments and competent human resources enables the use of a variety of interventions at several levels of care for persons with mental illness and makes it feasible to ensure observance of quality in the treatment approaches that go beyond institutionalisation. However, unlike developed countries which are endowed with many and relatively well-paid mental health specialists, low-income countries face a dire shortage of highly trained mental health professionals in addition to several other challenges. In light of this, there is need to re-assess the role of the few available psychiatrists, with a shift to new core tasks such as designing mental health care programmes that can be delivered by non-specialists, building their health system's capacity for delivering care, including supporting front-line health workers through support supervision, raising awareness on mental health and patients’ rights in addition to promoting essential research. This requires a fundamental paradigm shift from the current training for mental health specialists to a public health oriented approach and providing incentives for community engagement.

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How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

10.1101/2020.12.23.20248794 ◽

2020 ◽

Author(s):

Andreas Koehler ◽

Joz Motmans ◽

Leo Mulió Alvarez ◽

David Azul ◽

Karen Badalyan ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Health Care ◽

Low Income ◽

Social Group ◽

High Income ◽

Transgender People ◽

Middle Income ◽

Transgender Health ◽

The Impact

AbstractBackgroundSince the beginning of the COVID-19 pandemic, access to medical care was restricted for nearly all non-acute medical conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments (e.g., hormone treatment), transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. This study aims to assess the impact of the COVID-19 pandemic on the health and health care of transgender people.Methods and findingsAs an ad hoc collaboration between researchers, clinicians, and 23 community organizations, we developed a web-based survey. The survey was translated into 26 languages, and participants were recruited via various social media and LGBTIQ-community sources. Recruitment started in May 2020. We assessed demographical data, physical and mental health problems (e.g., chronic physical conditions), risk factors (e.g., smoking), COVID-19 data (symptoms, contact history, knowledge and concerns about COVID-19), and the influence of the COVID-19 pandemic on access to transgender health care and health-related supplies. To identify factors associated with the experience of restrictions to transgender health care, we conducted multivariate logistic regression analysis.5267 transgender people from 63 higher-middle income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding testing or treatment of a COVID-19 infection due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted due to the COVID-19 pandemic for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% of the participants reported at least one mental health conditions. Every third participant had suicidal thoughts, and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. A limitation of the study is that we did not analyze data from low-income countries and access to the internet was necessary to participate.ConclusionsTransgender people are assumed to suffer under the severity of the pandemic even more than the general population due to the intersections between their status as a vulnerable social group, their high amount of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender individuals, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behaviour, and suicidality.

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Conclusions

10.1093/med/9780198788065.003.0022 ◽

2016 ◽

Author(s):

Andrew Molodynski ◽

Tom Burns ◽

Jorun Rugkåsa

Keyword(s):

Mental Health ◽

Health Care ◽

Community Mental Health ◽

Low Income ◽

Theory And Practice ◽

Low Income Countries ◽

Community Mental Health Care ◽

Relative Lack ◽

Recent Developments ◽

Restrictive Legislation

This concluding chapter draws together the volume and combines theory and practice to provide an overview of the issue of community coercion in its widest sense. It confronts the enormous global variation in these issues, from ‘overly restrictive’ legislation in high-income countries to the absolute or relative lack of available care in low-income countries, particularly those in Africa and Asia. The overlapping and contrasting roles of the state, families, clinicians, and other involved agencies are considered. Finally the chapter identifies key themes in these practices and recent developments. It outlines ways forward to understand and measure coercion better and to reduce the need for it in community mental health care.

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Mental health of refugees in primary care

Oxford Textbook of Migrant Psychiatry ◽

10.1093/med/9780198833741.003.0051 ◽

2021 ◽

pp. 431-438

Author(s):

Edvard Hauff ◽

Reidun Brunvatne

Keyword(s):

Mental Health ◽

Health Care ◽

Low Income ◽

Mental Health Problems ◽

Early Stage ◽

Healthcare Services ◽

Low Income Countries ◽

Torture Survivors ◽

Early Screening ◽

Vulnerable Patients

Primary health care is usually the first level of formal health services that refugees meet in the country of resettlement. Providing culture-sensitive, accessible, and equitable services is a major challenge in high-income countries but even more so in middle- and low-income countries, where there are fewer resources. Presenting complaints are often multiple and complex. Early screening for mental health problems is controversial, and the priority is to establish a good working alliance and trust at an early stage. Vulnerable patients who may have limited or no social support or social capital due to split families; women and children exposed to sexual violence or trafficking; and torture survivors need special care and attention. Healthcare services are often fragmented making it difficult for people to traverse these services. Furthermore, there is a general need for competency building. The organization of primary mental health care for refugees in Norway is described as an example and a lesson for other countries who are facing similar problems.

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