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Community mental health: Theory, practices and perspectives

WYNGAERDEN, Francois
May 2018

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Mental health problems are commonplace and affect more than one in four people worldwide. They are responsible for a quarter of all disabilities. This document aims to provide a basis for exploring these concepts as part of more in-depth work, including an update of the 2011 mental health framework document.

 

A seminar was held in Kigali, Rwanda on 7 - 9 December 2017. It brought together 45 participants from 12 countries to think about and discuss community mental health concepts and practices. The objectives of this document are twofold:

• Set out analysis by an external expert, with a focus on community mental health at HI, in light of the literature and concepts and practices within the sector

• Undertake preliminary work to identify new concepts for implementation, based on the aspects covered in the seminar, as part of ongoing in-depth work in this area, including the updating of the 2011 mental health framework document.

 

Case histories from Rwanda, Lebanon and Madascagar are given. There is an extensive bibliography in the Annex

 

This document is intended for HI and partner staff members who work in the mental health and psychosocial support sector. It is also intended for HI staff working on mental health strategy. It can also be used to feed into the work of field staff developing, implementing and assessing mental health and psychsocial support programmes

Where there is no psychiatrist A mental health care manual

PATEL, Vikram
HANLON, Charlotte
March 2018

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This is a practical manual about mental health care, aimed at community health workers, primary care nurses, social workers and primary care doctors, particularly in low resource settings. It describes more than 30 clinical problems associated with mental illness, using a problem-solving approach to guide the reader through their assessment and management. It addresses the lack of understanding of mental health among many health workers. Mental health issues as they arise in specific contexts are described - in refugee camps, in school health programmes, as well as in mental health promotion. The final section helps the reader to personalise for a particular location, for example, by entering local information on voluntary agencies, the names and costs of medicines and words in the local language for symptoms.

 

This product is an update of the first edition 2003. It is also available as Open Access.

Problem Management Plus (PM+) Individual psychological help for adults impaired by distress in communities exposed to adversity

WORLD HEALTH ORGANIZATION
2016

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With this manual, the World Health Organization (WHO) is responding to requests from colleagues around the world who seek guidance on psychological interventions for people exposed to adversity.

The manual describes a scalable psychological intervention called Problem Management Plus (PM+) for adults impaired by distress in communities who are exposed to adversity. Aspects of Cognitive Behavioural Therapy (CBT) have been changed to make them feasible in communities that do not have many specialists. To ensure maximum use, the intervention is developed in such a way that it can help people with depression, anxiety and stress, whether or not exposure to adversity has caused these problems. It can be applied to improve aspects of mental health and psychosocial well-being no matter how severe people’s problems are.

Improving Ghana’s mental healthcare through task-shifting-psychiatrists and health policy directors perceptions about government’s commitment and the role of community mental health workers

AGYAPONG, Vincent
et al
October 2016

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The aim of this study was to examine the perceptions of psychiatrists and health policy directors about the policy to expand mental health care delivery in Ghana through a system of task-shifting from psychiatrists to community mental health workers (CMHWs). A self-administered semi-structured questionnaire was developed and administered to 11 psychiatrists and 29 health policy directors. Key informant interviews were also held with five psychiatrists and four health policy directors. .

Globalization and Health (2016) 12:57

DOI 10.1186/s12992-016-0199-z

Human Rights

www.macao-tz.org
December 2014

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Malezi AIDS Care Awareness Organization (MACAO) is a non-profit organization reaching out to neglected Indigenous people in Ngorongoro District, Arusha Region of Northern Tanzania.  Macao founded in 2003, Macao is a humanitarian organization that provides assistance to approximately 200,000 Indigenous Maasai community in Ngorongoro district for addressing needs of water and sanitation, food security, health Care Research, Education, Research environment, Maasai Traditional Research, Human Rights and sustainable economic development by strengthening their livelihoods.  In addition to responding to major relief situations, MACAO focuses on long-term community development through over 4 Area Development Project. We welcome the donors and volunteers to join us in this programs, we are wolking in ruro villages.

The evolution of community physiotherapy in India

RAJAN, Pavithra
February 2014

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Despite the urgent need for physiotherapy services for underprivileged communities, Community Physiotherapy is not a sought-after specialisation in India. Physiotherapists tend to serve in institutions rather than at community level, as a result of which this field of healthcare has stagnated. This article, based on an interview with one of the country’s eminent community physiotherapists, gives a first person account of the evolution of community physiotherapy in India and provides qualitative inputs to deal with the prevalent issues. While the need for services has increased, there has been no matching growth in the pool of physiotherapists willing to work in the community. Several recommendations have been made, including changes in approach to community physiotherapy by both physiotherapists as well as community organisations in India.

Compendium of accessible WASH technologies

JONES, Hazel
WILBUR, Jane
2014

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This compendium of accessible WASH technologies is designed for use by staff, such as health workers and community volunteers, working directly with communities in rural areas of sub-Saharan Africa. A few examples of technologies are presented that families can adapt to suit their needs and budgets with many more options possible. Most of the ideas are geared towards disabled and older people, but are suitable for anyone who may have difficulty using standard facilities, such as pregnant women, children and people who are ill. The main focus is on household facilities, although some ideas might be useful for institutional facilities as well

Ways to get people thinking and acting : village theatre and puppet show [Chapter 27]

WERNER, D
BOWER, B
2012

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This chapter explores role playing, sociodramas, people’s theater, and puppet shows as forms of action-packed group story-telling for health workers. Each can be used to explore problems or situations by acting them out and learning processes are provided for both actors and watchers based upon participation and discovery
Chapter 27 of "Helping Health Workers Learn" by D. Warner and B. Bower

Field based training for mental health workers, community workers, psychosocial workers and counselors : a participant-oriented approach

VAN DER VEER, Guus
FRANCIS, Felician Thayalara
July 2011

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"This article discusses the training of mental health workers whose basic job is with clients that have been seriously affected by armed conflict and/or natural disasters by using ‘helping through talking’, and who have had little education that is relevant to this work. It sums up the characteristics required of the workers, their learning needs, the messages that the training needs to convey, and the characteristics and potential contents of a tailor made, participants-oriented programme"
Intervention, Vol 9, Issue 2

CBR matrix and perceived training needs of CBR workers : a multi-country study

DEEPAK, Sunil
et al
2011

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"This study shows that CBR Matrix can be a useful framework to understand field-level activities in CBR projects. The study has identified a number of priority learning needs, in terms of different domains of CBR Matrix, and in terms of different disabilities. It also shows that globally, areas related to advocacy, lobbying, legal protection and rights-based approach, are the most important learning needs identified by CBR workers"
Disability, CBR and Inclusive Development, Vol 22, No 1

The balanced counseling strategy plus : a toolkit for family planning service providers working in high HIV/STI prevalence settings

POPULATION COUNCIL
2011

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"This "is an interactive, client-friendly approach for improving counseling on family planning and prevention, detection, and treatment of sexually transmitted infections (STIs) including HIV. The BCS+ was adapted from the Balanced Counseling Strategy, an evidence-based and well-researched tool for improving counseling on contraceptive methods. The BCS+ toolkit, developed and tested in Kenya and South Africa, provides the information and materials needed for health care facility providers to provide complete and high-quality family planning counseling to clients who live in areas with high rates of HIV and STIs.The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts
This second edition toolkit includes the following: * BCS+ Trainer’s Guide: Supervisors and others can use this to train health care facility directors and service providers on how to use the BCS+ for counseling family planning clients. * BCS+ User’s Guide: This guide focuses on how to implement the Balanced Counseling Strategy Plus. It can be distributed during training or used on its own with the BCS+ job aids. * BCS+ job aids comprising: - BCS+ algorithm that summarizes the 19 steps needed to implement the BCS+ during a family planning counseling session. These steps are organized into four stages: pre-choice, method choice, post-choice, and STI/HIV counseling. - BCS+ counseling cards that the provider uses during a counseling session. There are 26 counseling cards, the first of which contains six questions that the service provider asks to rule out the possibility a client is pregnant. Each of the next 16 cards contains information about a different family planning method. The next 3 cards provide advice on pregnancy and the postpartum period. The last 6 cards provide essential information for counseling on preventing, detecting, and treating STIs and HIV. - BCS+ method brochures on each of the 16 methods represented by the counseling cards. The brochures provide counseling to clients on the method they have chosen and then are given to clients for later reference. This means clients do not have to rely on their recollection of what was discussed with the provider. - WHO Medical Eligibility Criteria Wheel (offsite link) guides providers through medical conditions and medications that may be contraindications to use of particular contraceptive methods. The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts"
A video describing use of the BCS+ toolkit in South Africa also is available. To obtain Microsoft Word versions of BCS+ files to modify or revise according to your local setting, please contact the publisher

Factors affecting recruitment and retention of community health workers in a newborn care intervention in Bangladesh

RHAMAN, Syed Moshfiqur
et al
2010

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This is a summary of research which investigated the reasons for high rates of community health worker (CHW) attrition in Sylhet District in northeastern Bangladesh. Well-trained and highly motivated CHWs are critical for delivery of many community-based newborn care interventions. High rates of CHW attrition undermine programme effectiveness and potential for implementation at scale

Africa's health worker crisis - an interview with Dr Peter Ngatia

AFRICA MEDICAL RESEARCH FOUNDATION (AMREF)
April 2009

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This interview with Dr Peter Ngatia, former faculty head at the Kenya Medical Training Centre, explores the critical lack of health workers of all levels throughout the continent of Africa and its implications. It also discusses programmes that have been set up to train community health workers to help provide at least minimum access to health care providers, particularly for rural communities

A handbook for network support agents and other community workers supporting HIV prevention, care, support and treatment

March 2009

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This manual is intended to help network support agents and other community workers be more effective in disseminating standardised information about HIV and AIDS. It "...emphasises the importance of the acquisition of knowledge, skills and the right attitude needed to identify the psychosocial needs of people of people infected and affected by HIV/AIDS and address these needs by giving information, counselling and appropriate referrals. Knowledge of counselling and psychosocial care, is combined as much as possible with prevention activities such as adopting HIV basic care positive prevention and adherence to treatment"

An introduction to mental health : facilitator’s manual for training community health workers in India

RAJA, Shoba
et al
2009

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The aim of this training manual is to build the capacity of community health workers in the field of mental health so that they are able to effectively respond to the mental health needs of their communities. By the conclusion of the training, participants will be able to: * Recognise symptoms of mental disorders. * Respond appropriately to people experiencing symptoms of mental disorders. * Refer people experiencing possible mental disorders to appropriate services. * Support people with mental disorders and their families. * Promote mental health within their communities. The manual provides a step by step guide to facilitating each training session and contains information on teaching methods, training tips and the aims and objectives of each session. It was developed and piloted in consultation with the Village Health Workers at the Comprehensive Rural Health Project, Jamkhed, Maharashtra, India

The influence of HIV/AIDS on community-based rehabilitation in Dar es Salaam, Tanzania

BOYCE, William
COTE, Laurence
January 2009

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This paper examines the impact of HIV and AIDS on community-based rehabilitation (CBR) in Dar es Salaam, Tanzania. Over a three-month period, observational sessions and individual interviews were conducted with caregivers of children with disabilities, CBR workers and managers. Among the findings was a significant decrease in CBR activities in families affected by HIV and AIDS. It is recommended that further integration of CBR work with general health development initiatives might improve this situation

Popular theater [Chapter 48]

WERNER, David
2009

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This chapter presents information about how community theater can be used to raise awareness about specific needs of disabled persons or to gain greater participation of local people in a community rehabilitation programme. It also highlights that community theatre can be a good method for educating people about important preventive measures and recommends that actors can be disabled persons, parents of disabled children, health workers, rehabilitation workers, schoolchildren, or any combination of these
Chapter 48 of "Disabled Village Children" by David Warner

Playgrounds for all children [Chapter 46]

WERNER, David
2009

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This chapter presents information about how to involve local people in building low-cost rehabilitation playgrounds that should be built for use by all children, both disabled and non-disabled. Examples of playgrounds and equipment are provided
Chapter 46 of "Disabled Village Children" by David Warner

Annual review of HRH situation in Asia-Pacific region 2006-2007

DING Yang
TIAN Jiang
August 2008

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"This report reviews the Human Resources for Health (HRH) status in the targeted countries by mainly focusing on health education and training, distribution and retention of health workers, community health workers. Eighteen countries have been included in the report: Bangladesh; Cambodia; China; Fiji; India; Indonesia; Lao PDR; Myanmar; Nepal; Philippines; Papua New Guinea; Samoa; Sri Lanka; Thailand; Vietnam; Australia; New Zealand and Mongolia"

Taking critical services to the home : scaling-up home-based maternal and postnatal care, including family planning, through community midwifery in Kenya

MWANGI, Annie
WARREN, Charlotte
2008

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This publication is the report of a project to scale-up a community-based model, in Kenya, that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. The findings of the project were that community midwifery contributed to increasing the proportion of women assisted by skilled attendants during birth in the four districts in which the scheme was trialed, amounting to just under half of all skilled attended births in the districts. Although the skilled birth attendant rate in these districts was well below the national average of 42 percent, there was a steady increase in the proportion of attended deliveries since CMs were introduced in 2005. The districts also reported an increase in postnatal assessments in the first 48 hours and increase in immunization coverage

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