Contemporary Issues in Mental Health Care in sub-Saharan Africa

2017 ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Acceptance and Commitment Therapy in a Low-Income Country in Sub-Saharan Africa: A Call for Further Research

2021 ◽  
Vol 9 ◽  
Author(s):  
Yonas E. Geda ◽  
Janina Krell-Roesch ◽  
Yaphet Fisseha ◽  
Aida Tefera ◽  
Teferra Beyero ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Acceptance And Commitment Therapy ◽  
Mental Health Professionals ◽  
Sub Saharan Africa ◽  
Task Sharing ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Sub Saharan

A worsening trend of critical shortages in senior health care workers across low- and middle-income countries (LMICs) in sub-Saharan Africa has been documented for decades. This is especially the case in Ethiopia that has severe shortage of mental health professionals. Consistent with the WHO recommended approach of task sharing for mental health care in LMICs, Acceptance and Commitment Therapy (ACT), which is an empirically validated psychological intervention aimed at increasing psychological flexibility, may be delivered by trained laypersons who have a grassroots presence. In this paper, we discuss the need for and potential role of ACT to be delivered by health extension workers (HEWs) to address mental health care needs across Ethiopia. To this end, we also reviewed previous studies that have examined the effectiveness of ACT-based interventions in African countries including in Nigeria, Sierra Leone, Uganda, and South Africa. All studies revealed significant improvements of various mental health-related outcome measures such as decreased psychological distress and depressive symptoms, or increased subjective wellbeing and life satisfaction in the groups that received an ACT-based intervention. However, to date, there is no study that applied ACT in Ethiopia. Thus, more research is warranted to examine the effectiveness and, if proven successful, to scale up a task sharing approach of an ACT-based intervention being delivered by trained HEWs at a grassroots level, possibly paving the way for an innovative, sustainable mental health service in Ethiopia as well as other African LMICs.

Coercion in community mental health care: African perspectives

2016 ◽  
Author(s):  
Atalay Alem ◽  
Catherine Manning
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Community Psychiatry ◽  
Faith Healing ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Scarcity Of Resources ◽  
First Time

Mental health care on the African continent is plagued by a number of difficulties that range from a scarcity of resources to the stigma about and misunderstanding of mental illness itself. This chapter focuses on community psychiatry in Sub-Saharan Africa in particular and considers diverse issues such as economic shortages, stigma, faith healing, and the role of the family. It is the first time that such issues have been published in such a way, collating information from a variety of countries in the region. The authors have searched for all the available literature and assimilated it into a coherent narrative of ‘where we are’ with coercion in community psychiatry in Africa.

scholarly journals Scaling up public mental health care in Sub-Saharan Africa: insights from infectious disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Susan M. Meffert ◽  
Collene Lawhorn ◽  
Linnet Ongeri ◽  
Elizabeth Bukusi ◽  
Holly R. Campbell ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Mental Healthcare ◽  
Public Mental Health ◽  
Sub Saharan Africa ◽  
Care Needs ◽  
Public Mental Health Care ◽  
Sub Saharan

Abstract Introduction Models estimate that the disability burden from mental disorders in Sub-Saharan Africa (SSA) will more than double in the next 40 years. Similar to HIV, mental disorders are stigmatized in many SSA settings and addressing them requires community engagement and long-term treatment. Yet, in contrast to HIV, the public mental healthcare cascade has not been sustained, despite robust data on scalable strategies. We draw on findings from our International AIDS Society (IAS) 2020 virtual workshop and make recommendations for next steps in the scale up of the SSA public mental healthcare continuum. Discussion Early HIV surveillance and care cascade targets are discussed as important strategies for HIV response in SSA that should be adopted for mental health. Advocacy, including engagement with civil society, and targeted economic arguments to policymakers, are reviewed in the context of HIV success in SSA. Parallel opportunities for mental disorders are identified. Learning from HIV, communication of strategies that advance mental health care needs in SSA must be prioritized for broad global audiences. Conclusions The COVID-19 pandemic is setting off a colossal escalation of global mental health care needs, well-publicized across scientific, media, policymaker, and civil society domains. The pandemic highlights disparities in healthcare access and reinvigorates the push for universal coverage. Learning from HIV strategies, we must seize this historical moment to improve the public mental health care cascade in SSA and capitalize on the powerful alliances ready to be forged. As noted by Ambassador Goosby in our AIDS 2020 workshop, ‘The time is now’.

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.

scholarly journals Digital Mental Health Care in Humanitarian & Crisis Settings: A Mixed-Methods Exploration During The COVID-19 Pandemic

2021 ◽  
Author(s):  
Khasan Ibragimov ◽  
Miguel Palma ◽  
Gregory Keane ◽  
Janet Ousley ◽  
Madeleine Crowe ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Interpersonal Violence ◽  
Text Messaging ◽  
Sub Saharan Africa ◽  
Therapeutic Interventions ◽  
Medical Organization ◽  
Digital Platforms ◽  
June July

Abstract Background‘Digital Mental Health services,’ or mental health care delivered via internet, computers, mobile phones, tablets, or text messaging services, are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its mental health (MH) activities to digitally supported remote services in 2020 across humanitarian and resource-constrained settings. MethodsFrom June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of digital MH services provided during the COVID-19 crisis. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews (IDI) occurred.ResultsRespondents in 44 countries (6 world regions), mostly from Sub-Saharan Africa (39.5%), the Middle East (18.5%) and Asia (13.6%) participated. Most digital MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using digital interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using digital platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought digital MH services had some degree of utility, most commonly citing improved access to care (37.7%) and greater time efficiency (32.8%) as reasons for its continued use.ConclusionDigital MH activities were seen as an acceptable alternative to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the humanitarian contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering digital MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.

A survey of traditional and faith healers providing mental health care in three sub-Saharan African countries

2018 ◽  
Vol 54 (3) ◽  
pp. 395-403 ◽  
Author(s):  
Oluyomi Esan ◽  
John Appiah-Poku ◽  
Caleb Othieno ◽  
Lola Kola ◽  
Benjamin Harris ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
African Countries ◽  
Sub Saharan

scholarly journals Mental health capacity building in refugee primary health care settings in Sub-Saharan Africa: impact, challenges and gaps

2018 ◽  
Vol 5 ◽  
Author(s):  
C. Echeverri ◽  
J. Le Roy ◽  
B. Worku ◽  
P. Ventevogel
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Capacity Building ◽  
Sub Saharan Africa ◽  
Health Care Settings ◽  
Humanitarian Settings ◽  
Primary Health ◽  
Sub Saharan ◽  
Primary Health Care Settings

Background.In 2015, the United Nations High Commissioner for Refugees started a process of mental health capacity building in refugee primary health care settings in seven countries in Sub-Saharan Africa, ultimately aiming to decrease the treatment gap of mental, neurological and substance use (MNS) conditions in these operations. In 2015 and 2016, a specialized non-governmental organization, the War Trauma Foundation, trained 619 staff with the mental health gap action programme (mhGAP) Humanitarian Intervention Guide (HIG), a tool designed to guide clinical decision making in humanitarian settings.Methods.This paper describes the results of a process evaluation of a real-life implementation project by an external consultant, one and a half years after starting the programme.Results.The mhGAP-HIG capacity building efforts had various effects contributing to the integration of mental health in refugee primary health care. Facility-and community-based staff reported strengthened capacities to deliver mental health and psychosocial support interventions as well as changes in their attitude towards people suffering from MNS conditions. Service delivery and collaboration amongst different intervention levels improved. The scarcity of specialized staff in these settings was a major barrier, hindering the setting-up of supervision mechanisms.Conclusion.Mental health training of non-specialized staff in complex humanitarian settings is feasible and can lead to increased competency of providers. However, capacity building is a ‘process’ and not an ‘event’ and mhGAP trainings are only one element in a spectrum of activities aimed at integrating mental health into general health care. Regular supervision and continuing on-the-job training are in fact critical to ensure sustainability.

scholarly journals Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM

2015 ◽  
Vol 24 (3) ◽  
pp. 233-240 ◽  
Author(s):  
C. Lund ◽  
A. Alem ◽  
M. Schneider ◽  
C. Hanlon ◽  
J. Ahrens ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Health Care ◽  
Cost Effectiveness ◽  
Mental Disorders ◽  
Intervention Research ◽  
Sub Saharan Africa ◽  
Task Sharing ◽  
Treatment Gap ◽  
Sub Saharan

There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative research hub. AFFIRM is investigating strategies for narrowing the treatment gap for mental disorders in sub-Saharan Africa in four areas. First, it is assessing the feasibility, acceptability and cost-effectiveness of task-sharing interventions by conducting randomised controlled trials in Ethiopia and South Africa. The AFFIRM Task-sharing for the Care of Severe mental disorders (TaSCS) trial in Ethiopia aims to determine the acceptability, affordability, effectiveness and sustainability of mental health care for people with severe mental disorder delivered by trained and supervised non-specialist, primary health care workers compared with an existing psychiatric nurse-led service. The AFFIRM trial in South Africa aims to determine the cost-effectiveness of a task-sharing counselling intervention for maternal depression, delivered by non-specialist community health workers, and to examine factors influencing the implementation of the intervention and future scale up. Second, AFFIRM is building individual and institutional capacity for intervention research in sub-Saharan Africa by providing fellowship and mentorship programmes for candidates in Ethiopia, Ghana, Malawi, Uganda and Zimbabwe. Each year five Fellowships are awarded (one to each country) to attend the MPhil in Public Mental Health, a joint postgraduate programme at the University of Cape Town and Stellenbosch University. AFFIRM also offers short courses in intervention research, and supports PhD students attached to the trials in Ethiopia and South Africa. Third, AFFIRM is collaborating with other regional National Institute of Mental Health funded hubs in Latin America, sub-Saharan Africa and south Asia, by designing and executing shared research projects related to task-sharing and narrowing the treatment gap. Finally, it is establishing a network of collaboration between researchers, non-governmental organisations and government agencies that facilitates the translation of research knowledge into policy and practice. This article describes the developmental process of this multi-site approach, and provides a narrative of challenges and opportunities that have arisen during the early phases. Crucial to the long-term sustainability of this work is the nurturing and sustaining of partnerships between African mental health researchers, policy makers, practitioners and international collaborators.

scholarly journals It helps to talk: A guiding framework (TRUST) for peer support in delivering mental health care for adolescents living with HIV

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248018
Author(s):  
Carol Wogrin ◽  
Nicola Willis ◽  
Abigail Mutsinze ◽  
Silindweyinkosi Chinoda ◽  
Ruth Verhey ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Peer Support ◽  
Viral Suppression ◽  
Age Groups ◽  
Sub Saharan Africa ◽  
Mental Health Support ◽  
Health Support ◽  
Living With Hiv

Introduction Adolescents living with HIV have poor treatment outcomes, including lower rates of viral suppression, than other age groups. Emerging evidence suggests a connection between improved mental health and increased adherence. Strengthening the focus on mental health could support increased rates of viral suppression. In sub-Saharan Africa clinical services for mental health care are extremely limited. Additional mechanisms are required to address the unmet mental health needs of this group. We consider the role that community-based peer supporters, a cadre operating at scale with adolescents, could play in the provision of lay-support for mental health. Methods We conducted qualitative research to explore the experiences of peer supporters involved in delivering a peer-led mental health intervention in Zimbabwe as part of a randomized control trial (Zvandiri-Friendship Bench trial). We conducted 2 focus group discussions towards the end of the trial with 20 peer supporters (aged 18–24) from across 10 intervention districts and audio recorded 200 of the peer supporters’ monthly case reviews. These data were thematically analysed to explore how peer supporters reflect on what was required of them given the problems that clients raised and what they themselves needed in delivering mental health support. Results A primary strength of the peer support model, reflected across the datasets, is that it enables adolescents to openly discuss their problems with peer supporters, confident that there is reciprocal trust and understanding derived from the similarity in their lived experiences with HIV. There are potential risks for peer supporters, including being overwhelmed by engaging with and feeling responsible for resolving relationally and structurally complex problems, which warrant considerable supervision. To support this cadre critical elements are needed: a clearly defined scope for the manageable provision of mental health support; a strong triage and referral system for complex cases; mechanisms to support the inclusion of caregivers; and sustained investment in training and ongoing supervision. Conclusion Extending peer support to explicitly include a focus on mental health has enormous potential. From this empirical study we have developed a framework of core considerations and principles (the TRUST Framework) to guide the implementation of adequate supportive infrastructure in place to enhance the opportunities and mitigate risks.

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