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‘Restoring the person's life’: a qualitative study to inform development of care for people with severe mental disorders in rural Ethiopia

Published online by Cambridge University Press:  10 March 2016

S. Mall ,
M. Hailemariam ,
M. Selamu ,
A. Fekadu ,
C. Lund ,
V. Patel ,
I. Petersen  and
C. Hanlon
S. Mall
Affiliation:
Department for Psychiatry and Mental Health, University of Cape Town, Alan J. Flisher Centre for Public Mental Health, Rondebosch, South Africa
M. Hailemariam
Affiliation:
Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
M. Selamu
Affiliation:
Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
A. Fekadu
Affiliation:
Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Affective Disorders Research Group, SE5 8AF, London
C. Lund
Affiliation:
Department for Psychiatry and Mental Health, University of Cape Town, Alan J. Flisher Centre for Public Mental Health, Rondebosch, South Africa Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, SE5 8AF, London
V. Patel
Affiliation:
London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, WC1E 7HT, London Public Health Foundation of India, Centre for Chronic Conditions and Injuries, New Delhi, India Sangath Centre, Goa, India
I. Petersen
Affiliation:
School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
C. Hanlon*
Affiliation:
Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, SE5 8AF, London
*
*Address for correspondence: C Hanlon, Department for Psychiatry and Mental Health, University of Cape Town, Alan J. Flisher Centre for Public Mental Health, 46 Sawkins Road, Rondebosch, 7700, South Africa. (Email: charlotte.hanlon@kcl.ac.uk)
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Abstract

Aims.

In low-income countries, care for people with severe mental disorders (SMDs) who manage to access treatment is usually emergency-based, intermittent or narrowly biomedical. The aim of this study was to inform development of a scalable district-level mental health care plan to meet the long-term care needs of people with SMD in rural Ethiopia.

Methods.

The present study was carried out as formative work for the Programme for Improving Mental health CarE which seeks to develop, implement and evaluate a district level model of integrating mental health care into primary care. Six focus group discussions and 25 in-depth interviews were conducted with service planners, primary care providers, traditional and religious healers, mental health service users, caregivers and community representatives. Framework analysis was used, with findings mapped onto the domains of the Innovative Care for Chronic Conditions (ICCC) framework.

Results.

Three main themes were identified. (1) Focused on ‘Restoring the person's life’, including the need for interventions to address basic needs for food, shelter and livelihoods, as well as spiritual recovery and reintegration into society. All respondents considered this to be important, but service users gave particular emphasis to this aspect of care. (2) Engaging with families, addressed the essential role of families, their need for practical and emotional support, and the importance of equipping families to provide a therapeutic environment. (3) Delivering collaborative, long-term care, focused on enhancing accessibility to biomedical mental health care, utilising community-based health workers and volunteers as an untapped resource to support adherence and engagement with services, learning from experience of service models for chronic communicable diseases (HIV and tuberculosis) and integrating the role of traditional and religious healers alongside biomedical care. Biomedical approaches were more strongly endorsed by health workers, with traditional healers, religious leaders and service users more inclined to see medication as but one component of care. The salience of poverty to service planning was cross-cutting.

Conclusions.

Stakeholders prioritised interventions to meet basic needs for survival and endorsed a multi-faceted approach to promoting recovery from SMD, including social recovery. However, sole reliance on this over-stretched community to mobilise the necessary resources may not be feasible. An adapted form of the ICCC framework appeared highly applicable to planning an acceptable, feasible and sustainable model of care.

Keywords

Chronic care modelcommunity-based rehabilitationmental disordersprimary health carerecoveryschizophreniasocial inclusionsub-Saharan Africa
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 26 , Issue 1 , February 2017 , pp. 43 - 52
Copyright
Copyright © Cambridge University Press 2016 

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