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Dlamini MD, Chang YJ, Nguyen TTB. Caregivers' experiences of having a child with cerebral palsy. A meta-synthesis. J Pediatr Nurs 2023; 73:157-168. [PMID: 37690430 DOI: 10.1016/j.pedn.2023.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
AIM To synthesize qualitative research findings of caregiver experiences and challenges in caring for and raising a child with cerebral palsy. DESIGN A systematic review and meta-synthesis. METHODS Four electronic databases: CINAHL, Embase, OVID Medline, and Cochrane, were systematically searched for qualitative research papers published before December 2022. Two independent reviewers assessed eligibility and further appraised the quality of methodology using the Critical Appraisal Skills Program (CASP) tool for qualitative research. A content thematic analysis approach was used to synthesize the qualitative research findings, construct core subthemes, and synthesize themes. RESULTS Sixty-seven findings were extracted from the 12 included studies. The findings were grouped into eleven sub-themes and then into five synthesized themes. The synthesized themes are 1. Need for convenient healthcare facilities, therapeutic services, and accessible public places, 2. Need for healthcare information and financial aid, 3. Psychological, and physical constraints, 4. Societal rejection and stigma, and 5. Overwhelming caring burden. CONCLUSION Caregivers face many challenges in adjusting their lifestyles to meet the needs of the child with cerebral palsy. Some adjustments reported included giving up full-time jobs and businesses to be full-time caregivers, giving up leisure activities, and confinement to one place.
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Affiliation(s)
- Maggie Dumsile Dlamini
- Department of Nursing, College of Medicine, National Cheng Kung University, No1 University Road, Tainan 70101, Taiwan; Department of Nursing, Eswatini Christian Medical University, Lomkiri Portion 69 of Farm 73, Zone 4, Mbabane, Hhohho, Swaziland
| | - Ying-Ju Chang
- Professor, Institute of Allied Health Sciences & Department of Nursing, College of Medicine, National Cheng Kung University, No 1 University Road, Tainan 70101, Taiwan; Director, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Tram Thi Bich Nguyen
- Department of Nursing, College of Medicine, National Cheng Kung University, No1 University Road, Tainan 70101, Taiwan; Medical Simultaion Center, Duy Tan University, 254 Nguyen Van Linh, Da Nang, Viet Nam.
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2
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Nyassi S, Abdi YA, Minto J, Osman F. "Helping Mentally Ill, a Reward Both in this Life and After": A Qualitative Study Among Community Health Professionals in Somaliland. Community Ment Health J 2023; 59:1051-1063. [PMID: 36602699 PMCID: PMC10289922 DOI: 10.1007/s10597-022-01085-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to describe the experiences of community mental health workers, predominantly female, nurses and doctors providing community-based mental health services in Borama, Somaliland. A qualitative explorative study using focus group discussions was conducted. Data were collected from three focus group discussions with 22 female community health workers, two medical doctors, and two registered nurses and analyzed using content analysis with an inductive approach. Three main categories were identified from the analysis: (1) bridging the mental health gap in the community; (2) working in a constrained situation; and (3) being altruistic. Overall, the community mental health workers felt that their role was to bridge the mental health gap in the community. They described their work as a rewarding and motivated them to continue despite challenges and improving community healthcare workers' work conditions and providing resources in mental health services will contribute to strengthening mental health services in Somaliland.
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Affiliation(s)
- Sungkutu Nyassi
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
| | - Yakoub Aden Abdi
- College of Health Science, Amoud University, Amoud Valley, Borama, Somaliland Somalia
| | - John Minto
- University of the West of Scotland, Paisley, Scotland
| | - Fatumo Osman
- School of Health and Welfare, Dalarna University, 79188 Falun, Sweden
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3
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Olaoye A, Onyenankeya K. A systematic review of health communication strategies in Sub-Saharan Africa-2015-2022. Health Promot Perspect 2023; 13:10-20. [PMID: 37309431 PMCID: PMC10257569 DOI: 10.34172/hpp.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/08/2023] [Indexed: 06/14/2023] Open
Abstract
Background: Health communication strategies have become critical in managing public health issues across sub-Saharan Africa. In the literature, health communication strategies have been well documented. The studies are often narrow, focusing on individual countries or specific health issues. No research documented and consolidated the health communication strategies across sub-Saharan Africa. This review attempts to catalogue prevalent health communication strategies, how the various countries have implemented these strategies and the barriers to effective health communication practices in Africa. Methods: We systematically reviewed existing literature on health communication strategies in sub-Saharan Africa to answer formulated questions. A Google search was performed in October 2022 with the keywords 'health communication', 'strategies', 'promotion,' 'education,' and 'engagement,' The data reported in this article included evidence published between 2013 and 2023. Selected documents were content analyzed, and significant sections were mapped against specific strategies/themes. These subsets of data were used to present the results and analysis. Results:The review indicates that different health communication strategies have been deployed across Africa. In some countries, specific strategies are used to tackle specific health issues, while a combination of strategies is used in others. In some countries, the strategies are unclear, and implementation is improvised, sometimes misapplied, or truncated by bureaucratic red tape and incompetence. The prevalent strategies are mainly those prescribed from outside with little input from the beneficiaries. Conclusion: The review suggests that using a holistic or multi-pronged health communication approach that is context-specific and participatory could attract more uptakes of health messages.
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Affiliation(s)
- Adewale Olaoye
- University of Fort Hare, Alice, Eastern Cape, South Africa
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4
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A Systematic Review on Prevalence and Perceived Impacts of Associative stigma on Mental Health Professionals. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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5
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Korhonen J, Axelin A, Stein DJ, Seedat S, Mwape L, Jansen R, Groen G, Grobler G, Jörns-Presentati A, Katajisto J, Lahti M. Mental health literacy among primary healthcare workers in South Africa and Zambia. Brain Behav 2022; 12:e2807. [PMID: 36326480 PMCID: PMC9759138 DOI: 10.1002/brb3.2807] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders. METHODS The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL. RESULTS Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS. CONCLUSION The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.
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Affiliation(s)
- Joonas Korhonen
- Health and Well-being, Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Anna Axelin
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lonia Mwape
- Levy Mwanawasa Medical University, School of Nursing and Midwifery Sciences, Lusaka, Zambia
| | - Ronelle Jansen
- School of Nursing, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
| | - Gunter Groen
- Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany
| | - Gerhard Grobler
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Tshwane, South Africa
| | - Astrid Jörns-Presentati
- Department of Social Work, Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany
| | - Jouko Katajisto
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Mari Lahti
- Health and Well-being, Turku University of Applied Science, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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- Health and Well-being, Turku University of Applied Science, Turku, Finland
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Kayiteshonga Y, Sezibera V, Mugabo L, Iyamuremye JD. Prevalence of mental disorders, associated co-morbidities, health care knowledge and service utilization in Rwanda - towards a blueprint for promoting mental health care services in low- and middle-income countries? BMC Public Health 2022; 22:1858. [PMID: 36199102 PMCID: PMC9533613 DOI: 10.1186/s12889-022-14165-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background In order to respond to the dearth of mental health data in Rwanda where large-scale prevalence studies were not existing, Rwanda Mental Health Survey was conducted to measure the prevalence of mental disorders, associated co-morbidities and knowledge and utilization of mental health services nationwide within Rwanda. Methods This cross-sectional study was conducted between July and August 2018, among the general population, including survivors of the 1994 Genocide against the Tutsi. Participants (14–65 years) completed the Mini-International Neuropsychiatric Interview (Version 7.0.2), sociodemographic and epilepsy-related questionnaires. General population participants were selected first by random sampling of 240 clusters, followed by systematic sampling of 30 households per cluster. Genocide survivors within each cluster were identified using the 2007–2008 Genocide Survivors Census. Results Of 19,110 general survey participants, most were female (n = 11,233; 58.8%). Mental disorders were more prevalent among women (23.2%) than men (16.6%) (p < 0.05). The most prevalent mental disorders were major depressive episode (12.0%), panic disorder (8.1%) and post-traumatic stress disorder (PTSD) (3.6%). Overall, 61.7% had awareness of mental health services while only 5.3% reported to have used existing services. Of the 1271 genocide survivors interviewed, 74.7% (n = 949) were female; prevalence of any mental disorder was 53.3% for women and 48.8% for men. Most prevalent disorders were major depressive episode (35.0%), PTSD (27.9%) and panic disorder (26.8%). Among genocide survivors, 76.2% were aware of availability of mental health services, with 14.1% reported having used mental health services. Conclusions Despite high prevalence of mental disorders among the general population and genocide survivors, utilization of available mental health services was low. A comprehensive approach to mental health is needed for prevention of mental illness and to promote mental healthcare services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14165-x.
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Affiliation(s)
| | - Vincent Sezibera
- Department of Clinical Psychology, Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | - Lambert Mugabo
- Center for Mental Health, University of Rwanda, Kigali, Rwanda
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Davies T, Roomaney R, Lund C, Sorsdahl K. Evaluation of an Advocacy Programme for Mental Health Care Users in South Africa: A Mixed Methods Study. Community Ment Health J 2022; 58:720-728. [PMID: 34302562 DOI: 10.1007/s10597-021-00877-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
This study evaluates the implementation of a national advocacy programme for mental health care users, conducted by the South African National Department of Health and the South African Federation for Mental Health. Semi-structured interviews were conducted with care users (n = 18), service providers (n = 9), support persons (n = 6), NGO directors (n = 4), and programme managers in the DoH (n = 4). Although informational benefits were highlighted from programme empowerment sessions, very few advocacy groups were subsequently established. Barriers to establishing and conducting advocacy groups included a lack of follow-up support, pervasive stigma from communities and health care workers, low self-confidence, and a lack of financial resources. Facilitators for establishment of groups included conducting empowerment sessions and identifying 'mental health champions' at clinics, improving mental health training for health workers, dispensing psychiatric medication to patients on the same day, providing funding for non-governmental organisations, conducting national awareness campaigns, and establishing holistic rehabilitation centres for care users.
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Affiliation(s)
- T Davies
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, 46 Sawkins Rd., Rondebosch, Cape Town, 7700, South Africa
| | - R Roomaney
- Alan J. Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Matieland, 7602, South Africa
| | - C Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, 46 Sawkins Rd., Rondebosch, Cape Town, 7700, South Africa.,Centre for Global Mental Health, King's Global Health Institute, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, 46 Sawkins Rd., Rondebosch, Cape Town, 7700, South Africa.
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8
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Madlala D, Joubert PM, Masenge A. Community mental health literacy in Tshwane region 1: A quantitative study. S Afr J Psychiatr 2022; 28:1661. [PMID: 35402017 PMCID: PMC8991191 DOI: 10.4102/sajpsychiatry.v28i0.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/11/2021] [Indexed: 11/09/2022] Open
Abstract
Background Although mental health literacy is a major determining factor of mental health outcomes and functional capacity of individuals, there is dearth of research on the issue in South Africa. Aim To assess the literacy of three mental disorders, namely major depressive disorder (MDD), schizophrenia and generalised anxiety disorder (GAD) and to compare the resultant assumed literacy level between urban and townships participants. Setting Five clinics of region 1 in Tshwane, South Africa. Method A cross-sectional descriptive study was performed between November 2019 and January 2020. A total of 385 questionnaires were distributed equally in all five clinics. By means of questions about three fictive cases with clinical pictures indicative of MDD, schizophrenia and GAD the following were assessed: recognising a mental disorder, identifying the cause and knowledge about what would help best. Results The majority of participants (67.3%) recognised the clinical picture indicative of schizophrenia as a mental disorder, almost half of the participants (49.9%) recognised the clinical picture indicative of MDD as a mental disorder, whilst just more than one third (36.3%) of participants recognised the clinical picture GAD as a mental disorder. Concerning the causes for the clinical pictures, most participants indicated that stress was the cause for MDD and GAD (77.4% and 68.1%, respectively), whilst indicating that biological or psychological (59.5%) causes are relevant to the clinical picture indicative of schizophrenia symptoms. Fewer participants indicated supernatural causes for any of the clinical case (MDD: 2.6%; schizophrenia 15.3%; GAD 4.2%). Most participants chose professional help as the best option for all three cases (MDD 81.3%, schizophrenia 82.2%, GAD 66.1%). The indicators for health literacy in this study show that urban participants had better knowledge than township participants across all questions about the cases. Conclusion Overall, the study indicated a variable knowledge regarding the three mental disorders in region 1 of Tshwane and variable literacy levels in townships compared with urban settings. The results indicate that awareness campaigns should focus on the deficient areas.
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Affiliation(s)
- Dumisile Madlala
- Department of Health, Faculty of Health Sciences, Tshwane Mental Health District Services, Tshwane, South Africa
| | - Pierre M. Joubert
- Department of Psychiatry, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Andries Masenge
- Department of Statistics, Natural and Agricultural Science, University of Pretoria, Pretoria, South Africa
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EVITA 2.0, an updated framework for understanding evidence-based mental health policy agenda-setting: tested and informed by key informant interviews in a multilevel comparative case study. Health Res Policy Syst 2021; 19:35. [PMID: 33691696 PMCID: PMC7948345 DOI: 10.1186/s12961-020-00651-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Mental health remains a neglected issue on the global health policy agenda, particularly in low- and middle-income countries (LMIC), and the translation of research evidence into policy and practice is slow. The new EVITA framework was developed to improve mental health evidence uptake and policy agenda-setting in LMICs. In addition, behavioural science methods may be able to support knowledge translation to policy. Methods Using a mixed-methods study design, we applied and tested the newly developed EVITA 1.1 framework against three case studies related to South Africa at the district, national and international levels. In-depth interviews with 26 experts were conducted between August and November 2019, transcribed, coded and analysed in NVivo, using iterative categorization. The data were analysed against both the EVITA framework and the MINDSPACE framework for behavioural insights. Results In our case study comparison, we found that (1) research translation to the policy agenda occurs in a complex, fluid system which includes multiple “research clouds”, “policy spheres” and other networks; (2) mental health research policy agenda-setting is based on key individuals and intermediaries and their interrelationships; and (3) key challenges and strategies for successful research to policy agenda impact are known, but are frequently not strategically implemented, such as including all stakeholders to overcome the policy implementation gap. Our data also suggest that behavioural science methods can be strategically applied to support knowledge translation to policy agenda-setting. Conclusion We found that the EVITA framework is useful for understanding and improving mental health research policy interrelationships to support evidence uptake to the policy agenda, and that behavioural science methods are effective support mechanisms. The revised EVITA 2.0 framework therefore includes behavioural insights, for improved mental health policy agenda-setting in LMICs. More research is needed to understand whether EVITA can be applied to other LMICs and to high-income contexts.
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Qureshi O, Endale T, Ryan G, Miguel-Esponda G, Iyer SN, Eaton J, De Silva M, Murphy J. Barriers and drivers to service delivery in global mental health projects. Int J Ment Health Syst 2021; 15:14. [PMID: 33487170 PMCID: PMC7827991 DOI: 10.1186/s13033-020-00427-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery. There is a need to develop more feasible and evidence-based solutions through implementation research. This paper, one in a series pertaining to implementation in GMH projects worldwide, focuses on implementation factors influencing mental health service delivery. METHODS This is a qualitative study carried out as part of a Theory of Change-driven evaluation of Grand Challenges Canada's (GCC's) Global Mental Health portfolio. Purposive sampling was used to recruit twenty-nine GCC grantees for interviews. A semi-structured interview schedule was used to guide the interviews which were recorded and subsequently transcribed. Transcripts were double-coded and analyzed in NVivo 11 using framework analysis. This paper reports results related to detection and treatment of mental illness, mental health promotion and prevention of mental illness. RESULTS Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system. Formative research was a key driver facilitating the cultural adaptation of mental health detection, treatment, promotion and preventative approaches. Recruiting local providers and utilizing mHealth for improving screening, monitoring and data management were also found to be successful approaches in reducing workforce burden, improving sustainability, mental health literacy, participant engagement and uptake. CONCLUSIONS The study identifies a number of key barriers to and drivers of successful service delivery from the perspective of grantees implementing GMH projects. Findings highlight several opportunities to mitigate common challenges, providing recommendations for strengthening systems- and project-level approaches for delivering mental health services. Further, more inclusive research is required to inform guidance around service delivery for successful implementation, better utilization of funding and improving mental health outcomes among vulnerable populations in low-resource settings.
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Affiliation(s)
- Onaiza Qureshi
- Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Tarik Endale
- Department of Counseling and Clinical Psychology, Teachers College, Colombia University, 525 W 120th St, New York, NY 10027 USA
| | - Grace Ryan
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Georgina Miguel-Esponda
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Srividya N. Iyer
- Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, QC H3A 0G4 Canada
- Douglas Research Centre, 6875 Boulevard LaSalle, Montreal, QC H4H 1R3 Canada
| | - Julian Eaton
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
- CBM UK, 8 Oakington Business Park, Dry Drayton Rd, Oakington, CB24 3DQ UK
| | - Mary De Silva
- Health of Population Health, Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE UK
| | - Jill Murphy
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC V6T 2A1 Canada
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12
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Zaman S, Nahar P, MacGregor H, Barker T, Bayisenge J, Callow C, Fairhead J, Fahal A, Hounsome N, Roemer-Mahler A, Mugume P, Tadele G, Davey G. Severely stigmatised skin neglected tropical diseases: a protocol for social science engagement. Trans R Soc Trop Med Hyg 2020; 114:1013-1020. [PMID: 33324991 PMCID: PMC7738656 DOI: 10.1093/trstmh/traa141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
More than one billion people are affected by neglected tropical diseases (NTDs) and many of these diseases are preventable. While the grouping of these conditions as NTDs has generated vast mapping, mass drug administration and surveillance programmes, there is growing evidence of gaps and weaknesses in purely biomedical approaches, and the need for responses that also recognise the social determinants of health. In order to unpack the social and political determinants of NTDs, it is important to view the problem from a social science perspective. Given this background, the Social Sciences for Severe Stigmatizing Skin Diseases (5S) Foundation has recently been established by the Centre for Global Health Research at Brighton and Sussex Medical School. The broad aim of the 5S Foundation is to incorporate social science perspectives in understanding and addressing the problems around three NTDs, namely, podoconiosis, mycetoma and scabies. This protocol paper sets out the aims and approaches of the 5S Foundation while activities such as research, public engagement, training and capacity building get underway.
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Affiliation(s)
- Shahaduz Zaman
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Papreen Nahar
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Hayley MacGregor
- Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK
| | - Tom Barker
- Institute of Development Studies, University of Sussex, Brighton, BN1 9RE, UK
| | | | - Clare Callow
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - James Fairhead
- School of Global Studies, University of Sussex, Brighton, BN1 9S, UK
| | - Ahmed Fahal
- Mycetoma Research Centre, University of Khartoum, Khartoum, POB 102, Sudan
| | - Natalia Hounsome
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | | | | | - Getnet Tadele
- College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
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13
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Dowrick C, Kassai R, Lam CLK, Lam RW, Manning G, Murphy J, Ng CH, Thuraisingham C. The APEC Digital Hub-WONCA Collaborative Framework on Integration of Mental Health into Primary Care in the Asia Pacific. J Multidiscip Healthc 2020; 13:1693-1704. [PMID: 33268991 PMCID: PMC7701136 DOI: 10.2147/jmdh.s271070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
Mental ill health affects individual well-being and national economic prosperity and makes up a substantial portion of the burden of disease globally, especially in the Asia-Pacific region. Integrating mental health into primary care is widely considered a key strategy to improve access to mental health care. Integration, however, is a complex process that needs to be addressed at multiple levels. A collaboration between the Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health and the World Organization of Family Doctors (WONCA) is described in this paper, which outlines a framework and next steps to improve the mental health of communities in APEC economies. This paper notes gaps related to the integration of mental health into primary care across the region and identifies enablers and current best practices from several APEC economies. The potential of digital technology to benefit primary mental health care for populations in the APEC region, including delivery of training programs for healthcare staff and access to resources for patients, is described. Finally, key next steps are proposed to promote enhanced integration into primary care and improve mental health care throughout the APEC region.
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Affiliation(s)
- Chris Dowrick
- Department of Primary Care and Public Health, University of Liverpool, Liverpool, UK.,World Organization of Family Doctors (WONCA), Bangkok, Thailand
| | - Ryuki Kassai
- World Organization of Family Doctors (WONCA), Bangkok, Thailand.,Department of Community and Family Medicine, Fukushima Medical University, Fukushima, Japan
| | - Cindy L K Lam
- World Organization of Family Doctors (WONCA), Bangkok, Thailand.,Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health, Vancouver, BC, Canada
| | - Garth Manning
- World Organization of Family Doctors (WONCA), Bangkok, Thailand
| | - Jill Murphy
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Asia-Pacific Economic Cooperation (APEC) Digital Hub for Mental Health, Vancouver, BC, Canada
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Asia-Pacific Economic Cooperation(APEC) Digital Hub for Mental Health, Melbourne, Australia
| | - Chandramani Thuraisingham
- World Organization of Family Doctors (WONCA), Bangkok, Thailand.,Department of Family Medicine, International Medical University, Kuala Lumpur, Malaysia
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Mkabile S, Swartz L. 'I Waited for It until Forever': Community Barriers to Accessing Intellectual Disability Services for Children and Their Families in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8504. [PMID: 33212851 PMCID: PMC7698324 DOI: 10.3390/ijerph17228504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in urban Cape Town, South Africa, we interviewed a sub-group of families who had never used the intellectual disability services available to them, or who had stopped using them. METHODS We employed a qualitative research design and conducted semi-structured interviews to explore the views and perspectives of parents and caregivers of children with intellectual disability who are not using specialised hospital services. We developed an interview guide to help explore caregivers' and parents' views. RESULTS Results revealed that caregivers and parents of children with intellectual disability did not use the intellectual disability service due to financial difficulties, fragile care networks and opportunity costs, community stigma and lack of safety, lack of faith in services and powerlessness at effecting changes and self-stigmatisation. CONCLUSION Current findings highlight a need for increased intervention at community level and collaboration with community-based projects to facilitate access to services, and engagement with broader issues of social exclusion.
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Affiliation(s)
- Siyabulela Mkabile
- Department of Psychology, Stellenbosch University, Stellenbosch 7602, South Africa;
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7735, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch 7602, South Africa;
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15
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Abstract
BACKGROUND Studies in mental health care for low resource settings indicate that providing services at primary care level would significantly improve provision and utilisation of mental health services. Challenges related to inadequate funding were noted as significant barriers to service provision, with the contribution of low knowledge of mental health conditions and stigma in the community. This study aimed to explore the barriers to the use of mental health services in Zambia, suggesting health systems thinking approaches to solving these challenges. METHODS Primary data were collected through individual interviews from 12 participants; primary caregivers, health workers from public health institutions that treat mental health conditions and policymakers and implementers. The digitally recorded responses were transcribed and analysed using thematic analysis. RESULTS Key barriers to care included inadequate funding, few human resources, poor infrastructure and stigma. Barriers to care at policy, facility and individual or community level could be alleviated by strengthening the mental health system. Engagement of community health workers and increasing efforts to sensitise the community about mental health would prove beneficial. CONCLUSIONS Strengthening the community health systems for mental health could improve access and increase utilisation of services.
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Affiliation(s)
- Margarate Nzala Munakampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
- Strategic Centre for Health Systems Metrics & Evaluations (SCHEME), Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
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16
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Abstract
People of BAMME (Black, Asian, Minority, and Migrant ethnic) heritage in the UK experience various anomalies when engaging with mental health services. Typically concentrated at secondary and secure levels of care, these discrepant experiences interact with a reticence to uptake mental health support at the primary care level. Official, national anti-stigma campaigns often reproduce messages that do not connect with BAMME communities, raising questions about how best to challenge stigma in this context. This research paper describes a case study of an alternative means to address stigma, drawing from a dramatic comedy performance, Plant Fetish, written and performed by an artist who carries a diagnosis of complex post-traumatic stress disorder (Complex PTSD). The study comprised of an individual interview with the artist, audience feedback, and a group discussion conducted after the show. Data were subject to interpretative phenomenological analysis. Findings are discussed in relation to the importance of using creativity to increase public awareness of mental health and inform efforts to reduce stigma. We conclude that such approaches show promise and merit further exploration in a context of growing discursive interest in mental health amidst acknowledged deficiencies of contemporary anti-stigma efforts, especially as they apply to BAMME people, their families, and their communities.
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Davids EL, Adams Tucker L, Wambua GN, Fewster DL, Schlebusch L, Karrim SB, Attia M, Nyoni J, Bayouh FG, Kuteesa H, Brahim T, Hoogenhout M, Moussa Kahloul RB, Jearey-Graham N, Gobie HB, Nalugya JS. Child and adolescent mental health in Africa: A qualitative analysis of the perspectives of emerging mental health clinicians and researchers using an online platform. J Child Adolesc Ment Health 2020; 31:93-107. [PMID: 31570090 DOI: 10.2989/17280583.2019.1659145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Using a social ecological framework, this study aimed to establish emerging mental health clinicians and researchers' perspectives about child and adolescent mental health (CAMH) in Africa. Method: Perspectives of 17 participants from Ethiopia, Kenya, South Africa, Tunisia, Uganda and Zambia, whose professional backgrounds ranged from psychiatry to speech-language therapy, were collected at an African CAMH conference. Data were gathered using open-ended questions, using an online survey. Data were analysed using theoretical thematic analysis. Results: An adapted social ecological framework highlighted: An increased need for commitment from governments to improve CAMH in Africa; and addressing mental health stigma and discrimination through community awareness. The need for specialised CAMH facilities were identified, particularly in the public health sector. The need for multi-sectoral, multi-disciplinary partnerships for advocacy, service delivery, and continuity of care were also identified. Participants emphasised the importance of CAMH awareness, and the role of governments in recognising CAMH needs and using policies to improve CAMH in Africa. Participants were hopeful about the transformation of CAMH on the continent. Conclusion: The participants prioritised government- and community-level awareness to increase the resources and support offered by CAMH services in Africa.
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Affiliation(s)
- Eugene Lee Davids
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town , South Africa ; Cochrane South Africa, South African Medical Research Council, South Africa
| | - Leigh Adams Tucker
- Department of Psychology, University of the Western Cape , Bellville , South Africa
| | | | - Deborah Leigh Fewster
- Occupational Therapy Department, University of KwaZulu-Natal , Durban , South Africa
| | - Liezl Schlebusch
- Centre for Autism Research in Africa, Division of Child and Adolescent Psychiatry, University of Cape Town , South Africa
| | - Saira Bs Karrim
- Speech-Language Therapy, University of KwaZulu-Natal , Durban , South Africa
| | - Mouna Attia
- Psychiatry Department, University of Monastir , Monastir , Tunisia
| | - Joachim Nyoni
- Ministry of General Education, Directorate of Early Childhood Education , Lusaka , Zambia
| | | | - Hillary Kuteesa
- College of Health Science, Makerere University , Kampala , Uganda
| | - Takoua Brahim
- Psychiatry Department, University Hospital of Monastir , Monastir , Tunisia
| | - Michelle Hoogenhout
- Division of Developmental Paediatrics, University of Cape Town , South Africa ; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | | | | | - Habte Belete Gobie
- College of Medicine and Health Science, Bahir Dar University , Bahir Dar , Ethiopia
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18
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Mascayano F, Toso-Salman J, Ho YCS, Dev S, Tapia T, Thornicroft G, Cabassa LJ, Khenti A, Sapag J, Bobbili SJ, Alvarado R, Yang LH, Susser E. Including culture in programs to reduce stigma toward people with mental disorders in low- and middle-income countries. Transcult Psychiatry 2020; 57:140-160. [PMID: 31856688 DOI: 10.1177/1363461519890964] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality-most only included evaluations after intervention or short follow-up periods (1-3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jaime Sapag
- IMHPR, Centre for Addiction and Mental Health
- Mental Health, Catholic University of Chile
- Dalla Lana School of Public Health, University of Toronto
| | | | | | | | - Ezra Susser
- Columbia University
- New York University College of Global Public Health
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19
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Lien YY, Lin HS, Tsai CH, Lien YJ, Wu TT. Changes in Attitudes toward Mental Illness in Healthcare Professionals and Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234655. [PMID: 31766689 PMCID: PMC6926665 DOI: 10.3390/ijerph16234655] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 11/16/2022]
Abstract
Mental-illness-related stigma not only exists in the public but also in healthcare systems. Healthcare providers (HCPs) who have stigmatizing attitudes or behaviors might be thought of as a key barrier to mental health service use, and influence the quality of healthcare. Although cumulative projects have been conducted to reduce stigma related to mental illness among HCPs around the world, little is known about whether the attitudes of HCPs toward mental illness have changed over time. Research on this topic is mixed with respect to whether attitudes of HCPs toward mental illness have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on the Social Distance Scale (SDS), Opinions about Mental Illness (OMI), and Community Attitudes towards Mental Illness (CAMI) measures among health care professionals and students (N = 15,653) from 1966 to 2016. Our results indicated that both social distance (β = -0.32, p < 0.001) and attitudes (β = 0.43, p = 0.007) of HCPs toward mental illness have become increasingly positive over time. These findings provide empirical evidence to support that the anti-stigma programs and courses have positive effects on HCPs and can inform future anti-stigma programs focusing on improving the attitudes of HCPs toward mental illness, thereby improving the quality of healthcare provided.
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20
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Gray P, Senabe S, Naicker N, Kgalamono S, Yassi A, Spiegel JM. Workplace-Based Organizational Interventions Promoting Mental Health and Happiness among Healthcare Workers: A Realist Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224396. [PMID: 31717906 PMCID: PMC6888154 DOI: 10.3390/ijerph16224396] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/27/2019] [Accepted: 11/02/2019] [Indexed: 02/03/2023]
Abstract
Mental illness, deemed globally to account for 32% of years lived with a disability, generates significant impacts on workplaces. In particular, healthcare workers experience high rates of mental ill health such as burnout, stress, and depression due to workplace conditions including excessive workloads, workplace violence and bullying, which also produces negative effects on patients as well as on the happiness and wellbeing of those who remain at work. This review was undertaken to synthesize the evidence on workplace-based interventions at the organizational level promoting mental health and wellbeing among healthcare workers, to identify what has been receiving attention in this area and why, especially considering how such positive effects are produced. A search of three premier health-related databases identified 1290 articles that discussed healthcare workers, workplace interventions, and mental health. Following further examination, 46 articles were ultimately selected as meeting the criteria specifying interventions at the organizational level and combined with similar studies included in a relevant Cochrane review. The 60 chosen articles were then analyzed following a realist framework analyzing context, mechanism, and outcome. Most of the studies included in the realist review were conducted in high-income countries, and the types of organizational-level interventions studied included skills and knowledge development, leadership development, communication and team building, stress management as well as workload and time management. Common themes from the realist review highlight the importance of employee engagement in the intervention development and implementation process. The literature review also supports the recognized need for more research on mental health and happiness in low- and middle-income countries, and for studies evaluating the longer-term effects of workplace mental health promotion.
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Affiliation(s)
- Patricia Gray
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (P.G.); (A.Y.)
| | - Sipho Senabe
- Gauteng Department of Health, Gauteng Provincial Government, 45 Commissioner Street, Marshall Town (Johannesburg) 2147, South Africa;
| | - Nisha Naicker
- National Institute of Occupational Health, National Health Laboratory Service, Braamfontein, Johannesburg 2001, South Africa; (N.N.); (S.K.)
- School of Public Health, University of Witwatersrand, Parktown 2000, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg 2028, South Africa
| | - Spo Kgalamono
- National Institute of Occupational Health, National Health Laboratory Service, Braamfontein, Johannesburg 2001, South Africa; (N.N.); (S.K.)
- School of Public Health, University of Witwatersrand, Parktown 2000, South Africa
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (P.G.); (A.Y.)
| | - Jerry M. Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (P.G.); (A.Y.)
- Correspondence:
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21
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Bain K. The challenge to prioritise infant mental health in South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1177/0081246319883582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite clear evidence that infant mental health intervention is imperative, mental health services for infants and their caregivers worldwide remain under-prioritised, under-funded, and inaccessible to most populations. South Africa is no exception. This article proposes some potential explanations for this, exploring both practical constraints and possible resistances within the currents of our collective unconscious.
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Affiliation(s)
- Katherine Bain
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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22
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Bartholomew TT, Gentz SG. "How Can We Help You": Mental Health Practitioners' Experiences of Service Provision in Northern Namibia. Cult Med Psychiatry 2019; 43:496-518. [PMID: 31079350 DOI: 10.1007/s11013-019-09633-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although 12-13% of Namibians are reported to struggle with psychological distress, very few practitioners are available to provide mental health services in Namibia. Those practitioners who are available are often trained from Western counseling and psychiatric perspectives that may not readily align to beliefs about illness held constructed in Namibian cultures. Institutional effort is invested in the education and use of mental health practitioners, including counselors, social workers, nurses, psychologists, and psychiatrists. However, little is known about the experiences of these providers. Therefore, this study, a grounded theory ethnography, was undertaken as part of broader ethnographic work to understand how mental health practitioners (N = 7) in Northern Namibia view their work with Aawambo Namibians given that Namibian mental health practitioners are few but embedded in the country's health care system. Four categories were identified in analyses: Provision of Mental Health Services in the North, Practitioners' Conceptualizations of Psychological Distress: Western and Aawambo Influences, Beliefs about Mental Health Services in the North, and Integration of Traditional Treatment and Counseling. Results are discussed with respect to cultural competence in Namibian mental health practice and potential for integrating traditional practices and mental health services.
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Affiliation(s)
- Theodore T Bartholomew
- Department of Educational Studies, Purdue University, 5108 Beering Hall, West Lafayette, IN, 47907-2098, USA.
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23
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Field S, Abrahams Z, Woods DL, Turner R, Onah MN, Kaura DK, Honikman S. Accessible continued professional development for maternal mental health. Afr J Prim Health Care Fam Med 2019; 11:e1-e7. [PMID: 30843415 PMCID: PMC6407441 DOI: 10.4102/phcfm.v11i1.1902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 11/19/2022] Open
Abstract
Background Changing global health and development trends have resulted in a need for continued professional development (CPD) within the health and development sectors. In low-resource settings, where the need for training and CPD may be highest, there are significant challenges for disseminating information and skills. There is a need to improve mental health literacy and reduce levels of stigma about maternal mental illness. The Bettercare series of distance learning books provides a peer-based format for CPD. We aimed to evaluate the Bettercare Maternal Mental Health book as a format for CPD. Aim The aim of this study was to determine whether the Bettercare Maternal Mental Health book significantly improves knowledge and decreases stigma around mental health for care providers from the health and social development sectors. Setting One hundred and forty-one participants (social workers, nursing students and health professionals) were provided with the Bettercare Maternal Mental Health book to study. Methods Before and after studying the book, the same multiple-choice knowledge test and the Mental Illness Clinicians’ Attitude Scale were used to assess cognitive knowledge and mental health stigma, respectively. Results Participants’ knowledge showed a statistically significant (p < 0.001) improvement between the pre- and post-test results, for all six chapters of the book. However, participants’ attitudes towards mental illness did not show a statistically significant change between the pre- and post-test results. Conclusion We found that this method of learning elicited significant improvement in mental health knowledge for care providers. Continued professional development policy planners and curriculum developers may be interested in these findings.
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Affiliation(s)
- Sally Field
- Department of Psychiatry and Mental Health, University of Cape Town.
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McCann TV, Renzaho A, Mugavin J, Lubman DI. Stigma of mental illness and substance misuse in sub-Saharan African migrants: A qualitative study. Int J Ment Health Nurs 2018; 27:956-965. [PMID: 28990293 DOI: 10.1111/inm.12401] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/30/2022]
Abstract
Stigma of mental illness and substance misuse can deter help seeking, especially in immigrants who are often reluctant to seek help early for these issues. The aim of the present study was to explore the stigma experience surrounding mental illness and substance misuse, and its implications for improving help seeking, for youths and parents from sub-Saharan African immigrant communities. A qualitative, descriptive design was used. Individual interviews were undertaken with 28 youths, and focus group discussions were held with 41 parents and community leaders in Melbourne, Australia. The findings indicated that public stigma and self-stigma were common and deterred participants' help seeking within sub-Saharan African communities. There was concern about the consequences of disclosure. Personal shame, fear of community rejection, and being labelled a 'lunatic' deterred help seeking. Programmes are needed to address stigma, promote help seeking, and increase mental health knowledge. Mental health nurses and other clinicians in the mental health and alcohol and other drug fields can make an important contribution. Steps are needed to employ more sub-Saharan African immigrant clinicians to help increase help seeking from their communities.
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Affiliation(s)
- Terence V McCann
- Centre for Chronic Disease, Program of Nursing and Midwifery, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
| | - Andre Renzaho
- Humanitarian and Development Studies, Western Sydney University, Sydney, Australia
| | - Janette Mugavin
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia.,Turning Point, Monash University, Melbourne, Victoria, Australia
| | - Dan I Lubman
- Turning Point, Monash University, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Australia
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25
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Audet CM, Ngobeni S, Graves E, Wagner RG. Mixed methods inquiry into traditional healers' treatment of mental, neurological and substance abuse disorders in rural South Africa. PLoS One 2017; 12:e0188433. [PMID: 29261705 PMCID: PMC5736181 DOI: 10.1371/journal.pone.0188433] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/07/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Traditional healers are acceptable and highly accessible health practitioners throughout sub-Saharan Africa. Patients in South Africa often seek concurrent traditional and allopathic treatment leading to medical pluralism. METHODS & FINDINGS We studied the cause of five traditional illnesses known locally as "Mavabyi ya nhloko" (sickness of the head), by conducting 27 in-depth interviews and 133 surveys with a randomly selected sample of traditional healers living and working in rural, northeastern South Africa. These interviews were carried out to identify treatment practices of mental, neurological, and substance abuse (MNS) disorders. Participating healers were primarily female (77%), older in age (median: 58.0 years; interquartile range [IQR]: 50-67), had very little formal education (median: 3.7 years; IQR: 3.2-4.2), and had practiced traditional medicine for many years (median: 17 years; IQR: 9.5-30). Healers reported having the ability to successfully treat: seizure disorders (47%), patients who have lost touch with reality (47%), paralysis on one side of the body (59%), and substance abuse (21%). Female healers reported a lower odds of treating seizure disorders (Odds Ratio (OR):0.47), patients who had lost touch with reality (OR:0.26; p-value<0.05), paralysis of one side of the body (OR:0.36), and substance abuse (OR:0.36) versus males. Each additional year of education received was found to be associated with lower odds, ranging from 0.13-0.27, of treating these symptoms. Each additional patient seen by healers in the past week was associated with roughly 1.10 higher odds of treating seizure disorders, patients who have lost touch with reality, paralysis of one side of the body, and substance abuse. Healers charged a median of 500 South African Rand (~US$35) to treat substance abuse, 1000 Rand (~US$70) for seizure disorders or paralysis of one side of the body, and 1500 Rand (~US$105) for patients who have lost touch with reality. CONCLUSIONS While not all healers elect to treat MNS disorders, many continue to do so, delaying allopathic health services to acutely ill patients.
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Affiliation(s)
- Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, United States of America
| | - Sizzy Ngobeni
- MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Erin Graves
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, United States of America
| | - Ryan G. Wagner
- MRC/Wits Agincourt Research Unit, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden
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26
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Abayneh S, Lempp H, Alem A, Alemayehu D, Eshetu T, Lund C, Semrau M, Thornicroft G, Hanlon C. Service user involvement in mental health system strengthening in a rural African setting: qualitative study. BMC Psychiatry 2017; 17:187. [PMID: 28521749 PMCID: PMC5437561 DOI: 10.1186/s12888-017-1352-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. METHODS Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. RESULTS All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. CONCLUSION As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.
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Affiliation(s)
- Sisay Abayneh
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Heidi Lempp
- 0000 0001 2322 6764grid.13097.3cKing’s College London, Academic Rheumatology, Weston Education Centre, 10, Cutcombe Rd., London, SE5 9RJ UK
| | - Atalay Alem
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Daniel Alemayehu
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Tigist Eshetu
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Crick Lund
- 0000 0004 1937 1151grid.7836.aDepartment of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Rondebosch, Cape Town, 7700 South Africa ,0000 0001 2322 6764grid.13097.3cKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK
| | - Maya Semrau
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Graham Thornicroft
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Charlotte Hanlon
- Department of Psychiatry, University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia. .,King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, London, UK.
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Matsea TC. Strategies to destigmatize mental illness in South Africa: Social work perspective. SOCIAL WORK IN HEALTH CARE 2017; 56:367-380. [PMID: 28300502 DOI: 10.1080/00981389.2017.1284704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Stigma is a contributing factor to non-help-seeking behavior and social isolation of mental health-care users. The study examined social workers' perspective regarding strategies that can be implemented to destigmatize mental illness in South Africa. A qualitative study method was adopted. Data were sourced through focus group discussions with social work students and telephone interviews with social workers working in hospitals. Data were analyzed using a thematic approach. Active involvement, education, and awareness campaigns, creating opportunities for improved well-being and constant support, were identified as relevant strategies. Given that stigma is multidimensional, various strategies are important if mental illness is to be destigmatized.
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Lewandowski LB, Watt MH, Schanberg LE, Thielman NM, Scott C. Missed opportunities for timely diagnosis of pediatric lupus in South Africa: a qualitative study. Pediatr Rheumatol Online J 2017; 15:14. [PMID: 28231857 PMCID: PMC5322669 DOI: 10.1186/s12969-017-0144-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/29/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a serious multisystem autoimmune disease, which is more aggressive in children and people of African descent. In South Africa, pediatric SLE (pSLE) patients are at high risk for severe disease. Similar to pSLE worldwide, South African children and adolescents with SLE require subspecialized medical care. The aim of this study is to describe the care-seeking experiences of families and examine factors that contribute to delays in the diagnosis of pSLE. Specifically, we sought to identify factors to inform interventions that support the timely referral and diagnosis of pediatric SLE patients in South Africa. METHODS In-depth, semi-structured interviews were conducted with 22 caregivers of pSLE patients recruited from two government hospitals in Cape Town, South Africa in 2014. Interviews were audio-recorded, transcribed, and analyzed for themes related to barriers to diagnosis. RESULTS Six themes were identified and classified as either caregiver or health system barriers to diagnosis. Caregiver barriers included lack of knowledge regarding SLE, financial difficulties, and the social stigma of SLE. Health system barriers were lack of trained staff, a complex medical system, and misdiagnosis. CONCLUSION Caregivers reported missed opportunities for diagnosing pSLE in their children. Raising public awareness may improve caregiver awareness and reduce stigma of pSLE. Improving family education at diagnosis holds potential to increase patient-physician trust and mitigate fear. Education modules for primary care providers at initial point of contact with the health care system may improve recognition of early pSLE and facilitate expedited referral to a specialist.
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Affiliation(s)
- Laura B. Lewandowski
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12 N248 Room 28, Bethesda, MD 20892-1102 USA ,0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA ,0000000100241216grid.189509.cPediatric Rheumatology, Duke University Medical Center, 2301 Erwin Road, Durham, NC USA ,0000 0004 1937 1151grid.7836.aRed Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape South Africa
| | - Melissa H. Watt
- 0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Laura E. Schanberg
- 0000000100241216grid.189509.cPediatric Rheumatology, Duke University Medical Center, 2301 Erwin Road, Durham, NC USA
| | - Nathan M. Thielman
- 0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Christiaan Scott
- 0000 0004 1937 1151grid.7836.aRed Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape South Africa
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Burgess RA. Policy, power, stigma and silence: Exploring the complexities of a primary mental health care model in a rural South African setting. Transcult Psychiatry 2016; 53:719-742. [PMID: 28317469 DOI: 10.1177/1363461516679056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Movement for Global Mental Health's (MGMH) efforts to scale up the availability of mental health services have been moderately successful. Investigations in resource-poor countries like South Africa have pointed to the value of an integrated primary mental health care model and multidisciplinary collaboration to support mental health needs in underserved and underresourced communities. However, there remains a need to explore how these policies play out within the daily realities of communities marked by varied environmental and relational complexities. Arguably, the lived realities of mental health policy and service delivery processes are best viewed through ethnographic approaches, which remain underutilised in the field of global mental health. This paper reports on findings from a case study of mental health services for HIV-affected women in a rural South African setting, which employed a motivated ethnography in order to explore the realities of the primary mental health care model and related policies in South Africa. Findings highlighted the influence of three key symbolic (intangible) factors that impact on the efficacy of the primary mental health care model: power dynamics, which shaped relationships within multidisciplinary teams; stigma, which limited the efficacy of task-shifting strategies; and the silencing of women's narratives of distress within services. The resultant gap between policy ideals and the reality of practice is discussed. The paper concludes with recommendations for building on existing successes in the delivery of primary mental health care in South Africa.
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Affiliation(s)
- Rochelle Ann Burgess
- London Metropolitan University; University of Kwa-Zulu Natal; London School of Economics
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Douthit NT, Astatk HA. Factors affecting illness in the developing world: chronic disease, mental health and traditional medicine cures. BMJ Case Rep 2016; 2016:bcr-2016-215570. [PMID: 27485874 DOI: 10.1136/bcr-2016-215570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a case report of a 24-year-old Ethiopian woman with a medical history of hepatosplenic schistosomiasis. She suffers from chronic liver failure and portal hypertension. She has been hospitalised for 'hysteria' in the past but did not receive follow-up, outpatient treatment or psychiatric evaluation. After discontinuing her medications and leaving her family to use holy water, a religious medicine used by many Ethiopians, she was found at a nearby monastery. She was non-communicative and difficult to arouse. The patient was rushed to nearby University of Gondar Hospital where she received treatment for hepatic encephalopathy and spontaneous bacterial peritonitis. Her illness is the result of neglected tropical disease, reliance on traditional medicine as opposed to biomedical services and the poor state of psychiatric care in the developing world.
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Affiliation(s)
- Nathan T Douthit
- Ben Gurion University, Medical School for International Health, Be'er Sheva, Israel
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Iseselo MK, Kajula L, Yahya-Malima KI. The psychosocial problems of families caring for relatives with mental illnesses and their coping strategies: a qualitative urban based study in Dar es Salaam, Tanzania. BMC Psychiatry 2016; 16:146. [PMID: 27177934 PMCID: PMC4867081 DOI: 10.1186/s12888-016-0857-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/10/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental illness may cause a variety of psychosocial problems such as decreased quality of life of the patient's family members as well as increased social distance for the patient and the family caring for the patient. Psychosocial challenges are enhanced by the stigma attached to mental illness, which is a problem affecting not only the patient but also the family as a whole. Coping mechanisms for dealing with mentally ill patients differ from one family to another for a variety of reasons. The aim of the study was to determine the psychosocial problems of mental illness on the family including the coping strategies utilized by family members caring for a person with mental illness. METHOD A qualitative study was conducted, involving four focus group discussions and 2 in-depth interviews of family members who were caring for patient with mental illness at Temeke Municipality, Dar es Salaam. Purposive sampling procedure was used to select participants for the study. Audio-recorded interviews in Swahili were conducted with all study participants. The recorded interview was transcribed and qualitative content thematic analysis was used to analyse the data. RESULTS Financial constraints, lack of social support, disruption of family functioning, stigma, discrimination, and patients' disruptive behaviour emerged as the main themes in this study. Acceptance and religious practice emerged as the major coping strategies used by family members. CONCLUSION Familial care for a person with mental illness has its advantages, yet it has multiple social and psychological challenges. Coping strategies and skills are important for the well-being of the caregiver and the patient. Addressing these psychosocial challenges requires a collaborative approach between the health care providers and government so that the needs of the family caregivers and those of the patients can be addressed accordingly.
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Affiliation(s)
- Masunga K Iseselo
- Department of Clinical Nursing, Muhimbili University of Health & Allied Sciences (MUHAS), P.O.Box 65004, Dar es Salaam, Tanzania.
| | - Lusajo Kajula
- Department of Psychiatry and Mental Health, Muhimbili University of Health & Allied Sciences (MUHAS), P.O.Box 65001, Dar es Salaam, Tanzania
| | - Khadija I Yahya-Malima
- Tanzania Commission for Science & Technology (COSTECH), Ali Hassan Mwinyi Road, Kijitonyama (Sayansi) COSTECH Building, P.O. Box 4302, Dar es Salaam, Tanzania
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Abstract
Psychological distress is inherently constructed within contexts and the unique, cultural meaning systems that have developed to understand mental illness. Moreover, cultures naturally develop their own systems of healing, grounded in traditional practices. Western psychology and psychiatry have, through globalisation and colonial histories, imposed systems of mental health care and definitions of mental illness. In doing so, local understandings and ways of being regarding mental health have often been eclipsed. This is no less true in Namibia. However, much of the existing mental health literature from Namibia explores mental illness from a Western lens of psychopathology. This article discusses the relevant research about mental illness in Namibia and situates this within related literature from other Southern African countries. Several cultural factors across diverse groups in Namibia are important to more fully understand what mental illness and treatment are throughout this country. The cultural role of diverse conceptualisations of mental illness is discussed in order to explore potential areas of growth in Namibian mental health and intervention. The nature of traditional healing in other Southern African contexts is also addressed, given that although traditional healing exists in Namibia, researchers have not yet explored it within the context of psychological distress. Recommendations for mental health and psychological treatment in Namibia are discussed.
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Abstract
AIMS This paper aims to provide an overview of evidence from low- and middle-income countries (LAMICs) worldwide to address: the nature of stigma and discrimination, relevant context-specific factors, global patterns of these phenomena and their measurement and quantitative and qualitative evidence of interventions intended to reduce their occurrence and impact. The background to this study is that the large majority of studies concerned with identifying effective interventions to reduce stigma and discrimination originate in high-income countries (HICs). This paper therefore presents such evidence from, and relevant to, LAMICs. METHODS Conceptual overview of the relevant peer-reviewed and grey literature on stigma and discrimination related to mental illness in LAMICs are available in English, Spanish, French and Russian. RESULTS Few intervention studies were identified related to stigma re-education in LAMICs. None of these addressed behaviour change/discrimination, and there were no long-term follow-up studies. There is therefore insufficient evidence at present to know which overall types of intervention may be effective and feasible and in LAMICs, how best to target key groups such as healthcare staff, and how far they may need to be locally customised to be acceptable for large-scale use in these settings. In particular, forms of social contacts, which have been shown to be the most effective intervention to reduce stigma among adults in HICs, have not yet been assessed sufficiently to know whether these methods are also effective in LAMICs. CONCLUSION Generating information about effective interventions to reduce stigma and discrimination in LAMICs is now an important mental health priority worldwide.
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Egbe CO, Brooke-Sumner C, Kathree T, Selohilwe O, Thornicroft G, Petersen I. Psychiatric stigma and discrimination in South Africa: perspectives from key stakeholders. BMC Psychiatry 2014; 14:191. [PMID: 24996420 PMCID: PMC4099203 DOI: 10.1186/1471-244x-14-191] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 06/30/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stigma and discrimination against people with mental illness remain barriers to help seeking and full recovery for people in need of mental health services. Yet there is scarce research investigating the experiences of psychiatric stigma on mental health service users in low- and middle-income countries (LMICs). The aim of this study was therefore to explore the experiences of psychiatric stigma by service users in order to inform interventions to reduce such stigma and discrimination in one LMIC, namely South Africa. METHODS Participants comprised a total of 77 adults aged above 18 years, made up of service providers including professional nurses (10), lay counsellors (20), auxiliary social workers (2); and service users (45). RESULTS Psychiatric stigma was found to be perpetuated by family members, friends, employers, community members and health care providers. Causes of psychiatric stigma identified included misconceptions about mental illness often leading to delays in help-seeking. Experiencing psychiatric stigma was reported to worsen the health of service users and impede their capacity to lead and recover a normal life. CONCLUSION Media campaigns and interventions to reduce stigma should be designed to address specific stigmatizing behaviours among specific segments of the population. Counselling of families, caregivers and service users should include how to deal with experienced and internalized stigma.
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Affiliation(s)
- Catherine O Egbe
- Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa
| | - Carrie Brooke-Sumner
- Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa
| | - Tasneem Kathree
- Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa
| | - One Selohilwe
- Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, King's College, De Crespigny Park, London, UK
| | - Inge Petersen
- Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, King George V Avenue, Durban 4041, South Africa
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Laher S. An overview of illness conceptualizations in African, Hindu, and Islamic traditions: towards cultural competence. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2014. [DOI: 10.1177/0081246314528149] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Increasingly, research, teaching, and practice emphasize the need for cultural competency among healthcare practitioners. Most training programmes include modules on cultural competency based on a knowledge, skills, and awareness model. In line with the knowledge and awareness objectives of cultural competency, this article focuses on the conceptualization of illness from an Islamic, Hindu, and African perspective. It discusses spiritual illness, a category of illness recognized in all three traditions but marginalized in mainstream literature. This marginalization has given rise to debates as to whether a separate Islamic psychology, a Hindu psychology, African psychology (or other Psychology) should exist. This article explores these areas briefly concluding with arguments on the need for current teaching, research, and practice to take more cognizance of cultural views of illness.
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Affiliation(s)
- Sumaya Laher
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, South Africa
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Oshodi YO, Abdulmalik J, Ola B, James BO, Bonetto C, Cristofalo D, Van Bortel T, Sartorius N, Thornicroft G. Pattern of experienced and anticipated discrimination among people with depression in Nigeria: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:259-66. [PMID: 23851703 DOI: 10.1007/s00127-013-0737-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Stigma is commonly encountered by individuals with mental illness and leads to discrimination. These phenomena restrict access to and use of mental health care services. This study evaluated the impact of stigma and discrimination among individuals with major depression in Nigeria. METHODS A cross-sectional study was conducted across four tertiary psychiatric facilities located in different regions of Nigeria. Consenting adults attending the psychiatric units in the participating sites with a diagnosis of a major depressive disorder and having an episode within the past 12 months were recruited. Interviews were conducted using a socio-demographic questionnaire, the Discrimination and Stigma Scale, the Internalized Stigma of Mental Illness Scale, the Boston University Self Empowerment Scale, and the Rosenberg Self Esteem Scale. RESULTS One hundred and three interviews were completed. The mean age of the participants was 35.5 years. The most frequent item for experienced discrimination was being unfairly treated in dating or intimate relationships (13.6%), while concealment of mental illness was the most common for anticipated discrimination (51.5%). Younger people (age less than 40 years) with a higher level of education appear to be at high risk for experienced discrimination. CONCLUSIONS Important suggestions may be derived for clinicians, caregivers, and policy makers to appreciate the role of stigma in the burden, treatment, and rehabilitation of individuals with depression, especially for younger people with higher level of education.
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Affiliation(s)
- Yewande O Oshodi
- Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria
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Drew N, Funk M, Tang S, Lamichhane J, Chávez E, Katontoka S, Pathare S, Lewis O, Gostin L, Saraceno B. Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet 2011; 378:1664-75. [PMID: 22008426 DOI: 10.1016/s0140-6736(11)61458-x] [Citation(s) in RCA: 169] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This report reviews the evidence for the types of human rights violations experienced by people with mental and psychosocial disabilities in low-income and middle-income countries as well as strategies to prevent these violations and promote human rights in line with the UN Convention on the Rights of Persons with Disabilities (CRPD). The article draws on the views, expertise, and experience of 51 people with mental and psychosocial disabilities from 18 low-income and middle-income countries as well as a review of English language literature including from UN publications, non-governmental organisation reports, press reports, and the academic literature.
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Lund C, Kleintjes S, Cooper S, Petersen I, Bhana A, Flisher AJ, the MHaPP Research Programme Consor. Challenges facing South Africa's mental health care system: stakeholders' perceptions of causes and potential solutions. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/17542863.2010.503039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kleintjes S, Lund C, Swartz L, Flisher A. Mental health care user participation in mental health policy development and implementation in South Africa. Int Rev Psychiatry 2011; 22:568-77. [PMID: 21226645 DOI: 10.3109/09540261.2010.536153] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper describes current support for mental health care user participation in policy development and implementation in South Africa and suggests strategies for improving participation. The World Health Organization (WHO) Mental Health Policy Checklist and WHO Mental Health Legislation Checklist were completed. Between August 2006 and August 2009 96 semi-structured interviews with national, regional and district stakeholders were conducted. Most respondents felt that inclusion of user perspectives in policy processes would improve policy development. In practice, mental health care user consultation in policy development and implementation has been limited during the 16 years of democracy in South Africa. Strategies to create a supportive environment for user participation include social action directed at reducing stigma, advocating for acceptance of users' rights to participate in decision making, crafting a supportive regulatory framework to promote participation, and equipping providers and policy makers to support inclusion. User capacity for participation could be strengthened through early and effective access to treatment and support, development of a national user lobby, skills training and practical exposure to the policy and service development environment.
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Affiliation(s)
- Sharon Kleintjes
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa.
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Bhana A, Petersen I, Baillie KL, Flisher AJ. Implementing the World Health Report 2001 recommendations for integrating mental health into primary health care: a situation analysis of three African countries: Ghana, South Africa and Uganda. Int Rev Psychiatry 2011; 22:599-610. [PMID: 21226648 DOI: 10.3109/09540261.2010.536152] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Integrating mental health into primary health care is widely promoted for a host of reasons, chief among which is providing a more comprehensive health care service. However, only a few countries have adequate mental health resources to undertake the integration of mental health into primary health care in a uniform manner, with wide variations among countries. This paper examines the extent to which two low-income countries (Ghana and Uganda) and one middle-income country (South Africa) are managing the integration of mental health into primary health care using the recommendations of the WHO World Health Report, 2001. Primary and secondary data sources from a situational analysis of mental health services in the three countries were analysed. The findings indicate that significant challenges remain in integrating mental health care into primary health care. Poor or uneven implementation of policy, inadequate access to essential drugs and lack of mental health specialists are some of the reasons advanced. Aside from better human resource planning for mental health, integration may be advanced by the development of packages of care which adopt a task-shifting approach suited to a country's needs.
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Affiliation(s)
- Arvin Bhana
- Human and Social Development, Human Sciences Research Council, Durban, South Africa.
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Skeen S, Kleintjes S, Lund C, Petersen I, Bhana A, Flisher AJ. 'Mental health is everybody's business': roles for an intersectoral approach in South Africa. Int Rev Psychiatry 2011; 22:611-23. [PMID: 21226649 DOI: 10.3109/09540261.2010.535510] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Intersectoral action is increasingly recognized as necessary to address the social determinants of mental health. This study aims to assess South Africa's progress in intersectoral collaboration for mental health, and provide recommendations for intersectoral collaboration, to generate lessons for other low- and middle-income countries. We conducted a survey of the existing mental health system in South Africa using the World Health Organization Assessment Instrument for Mental Health Systems. We also conducted 96 semi-structured interviews and 12 focus group discussions with a range of stakeholders at national, provincial and district level. Data were analysed thematically to understand the roles and responsibilities of different sectors in realizing the right to mental health. A range of key sectors were identified as having roles in mental health promotion, illness prevention and service delivery. In discussing South Africa's progress, respondents gave several suggestions about how to formulate an intersectoral response in this context, including increasing high level political commitment, and using leadership from the health sector. We outline roles and responsibilities for various sectors and lessons that can be learnt from this context. These include the importance of developing programmes alongside legislation, employing targeted awareness-raising to engage sectors, and developing a structured approach to intersectoral action.
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Affiliation(s)
- Sarah Skeen
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa.
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Bird P, Omar M, Doku V, Lund C, Nsereko JR, Mwanza J. Increasing the priority of mental health in Africa: findings from qualitative research in Ghana, South Africa, Uganda and Zambia. Health Policy Plan 2010; 26:357-65. [PMID: 21147845 DOI: 10.1093/heapol/czq078] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite the high prevalence of mental illness, mental health remains a low priority in Africa. There has been no investigation of the views of stakeholders in Africa on why this is and what can be done. This paper reports a comparison of the views of stakeholders in Ghana, South Africa, Uganda and Zambia, focusing on the priority given to mental health by the government at the national and regional/province levels. We conducted semi-structured interviews with key stakeholders and used a two-stage approach to analysis: firstly framework analysis in each study country, followed by comparative analysis of the country data. Mental health was largely considered a low priority at national and regional/provincial levels in all four countries. We identified nine factors affecting the priority of mental health, which were grouped into three categories: legitimacy of the problem, feasibility of response and support for response. Respondents put forward a range of experiences and suggestions for increasing the priority given to mental health. We conclude with broad suggestions to raise the priority of mental health. These suggestions are particularly relevant as mental health increases in priority on the international agenda, in order to inform advocacy for increased priority for mental health in Africa.
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Affiliation(s)
- Philippa Bird
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK.
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