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.

scholarly journals Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries

2016 ◽  
Vol 26 (4) ◽  
pp. 348-354 ◽  
Author(s):  
C. Hanlon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Human Rights ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Mental Health Professionals ◽  
Task Sharing ◽  
Middle Income ◽  
Middle Income Countries

The explicit inclusion of mental health within the Sustainable Development Goals is a welcome development, borne out of powerful advocacy using public health, economic and human rights arguments. As funding comes on line for scale-up of evidence-based mental health care by task-sharing with primary care, it is time to take stock about care for people affected by severe mental illness (SMI). The existing evidence base for task shared care for SMI provides an imperative to get started, but is skewed towards relatively more affluent and urban populations in middle-income countries where specialist mental health professionals provide most of the care. Randomised, controlled trials and rigorous implementation research on task shared service models are underway which will go some way to improving understanding of the quality, safety, effectiveness and acceptability of more widely generalisable care for people with SMI. A sub-group of people with SMI have more complex and long-term needs for care, with a high risk of homelessness, imprisonment and human rights violations as family and social supports become overwhelmed. Case studies from non-governmental organisations provide examples of holistic approaches to rehabilitation, recovery and empowerment of people with SMI, but rigorous comparative studies are needed to identify the most efficient, effective and scalable approaches to care. Health system constraints are emerging as the over-riding barriers to successful task-sharing, highlighting a need to develop and evaluate chronic care models for people with SMI that succeed in reducing premature mortality, improving wellbeing and achieving better social outcomes. Addressing these evidence gaps is essential if task-sharing mental health care is going to deliver on its promise of promoting recovery for the full range of people affected by SMI.

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 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 Acceptance and Commitment Therapy with Ecological Systems Theory: Addressing Muslim Mental Health Issues and Wellbeing

2019 ◽  
Vol 3 (2) ◽  
pp. 197-219 ◽  
Author(s):  
Ahmet Tanhan
Keyword(s):  
Mental Health ◽  
Systems Theory ◽  
Acceptance And Commitment Therapy ◽  
Mental Health Professionals ◽  
Ecological Systems ◽  
Ecological Systems Theory ◽  
Research And Practice ◽  
Commitment Therapy ◽  
Acceptance And Commitment ◽  
Diverse Groups

Muslims across the word underutilize mental health services for addressing their wellbeing and biopsychosocial, spiritual, and contextual issues. By 2030, the global Muslim population is expected to reach 2.2 billion people. This indicates that Muslim mental health is gaining importance and would require contextually (i.e., spiritually, culturally, empirically) more effective services. Practitioners used Acceptance and Commitment Therapy (ACT) and Ecological Systems Theory (EST) to promote wellbeing and address psychopathology for diverse groups. However, rigorous and comprehensive literature from 1986 to 2019 did not produce research addressing how ACT could be consumed to serve Muslims. Researchers in Muslim mental health have suggested benefitting from EST yet only few have mentioned using ACT. ACT is one of the most effective therapies based on randomized control trials to enhance wellbeing and address psychopathology. The main purposes of this paper are to (a) explain how ACT is one of the most appropriate counseling approaches to be utilized with Muslims because ACT and Islam have many commonalities and (b) propose ACT with EST perspective to enable a much more contextual perspective of ACT so that mental health professionals could promote wellbeing and address psychopathology at all ecological levels for all, starting with Muslims. With the arrival of third and fourth wave of counseling approaches, the use of positive psychology in research and practice has increased dramatically. ACT, Islam, and EST also highly stress a positive approach perspective thus considering of ACT and EST together might promise more effective research and practice in positive and abnormal psychology.

Study Protocol for Implementation of An Internet-based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada (Preprint)

2021 ◽  
Author(s):  
Kenneth Po-Lun Fung ◽  
Mandana Vahabi ◽  
Masoomeh Moosapoor ◽  
Abdolreza Akbarian ◽  
Josephine Pui-Hing Wong
Keyword(s):  
Mental Health ◽  
Psychological Distress ◽  
Focus Groups ◽  
Acceptance And Commitment Therapy ◽  
Psychological Intervention ◽  
Self Care ◽  
Well Being ◽  
Virtual Space ◽  
Commitment Therapy ◽  
Acceptance And Commitment

BACKGROUND Psychological distress, isolation, feeling of powerlessness, and limited social support are realities faced by temporary migrant live–in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge about health resources, precarious employment, and immigration status. OBJECTIVE Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote mental well being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants’ satisfaction with the intervention and their perceived barriers and facilitators to practicing the self-care strategies embedded in WE2CARE will be examined. METHODS Thirty-six live- in caregivers residing in Great Toronto Area (GTA) will be recruited and randomly assigned to intervention and waitlist control groups. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online pre-, post-, and 6-week post-intervention to assess mental distress (DASS 21), psychological flexibility (AAQ-2), mindfulness (CAMS-R) and Multi-System Model of Resilience (MSMR-I). Two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program. RESULTS WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) in February 2019, and University of Toronto (RIS37623) in May 2019. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021. CONCLUSIONS WE2CARE can be a promising approach in reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation and utility of online delivery of ACT based psychological intervention in promoting mental health among disadvantaged and vulnerable populations. CLINICALTRIAL None

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