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Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PETERSEN, Inge
et al
February 2017

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The aim of this study was to identify key governance issues that need to be addressed to facilitate the integration of mental health services into general health care in the six participating "Emerald" countries (Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda).  The study adopted a descriptive qualitative approach, using framework analysis. Purposive sampling was used to recruit a range of key informants, to ensure views were elicited on all the governance issues within the expanded framework. Key informants across the six countries included policy makers at the national level in the Department/Ministry of Health; provincial coordinators and planners in primary health care and mental health; and district-level managers of primary and mental health care services. A total of 141 key informants were interviewed across the six countries. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesised at a cross-country level.

Evaluating the impact of a community–based parent training programme for children with cerebral palsy in Ghana

ZUURMOND, Maria
et al
January 2017

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"Cerebral palsy is the most common cause of physical disability in children worldwide, and yet in most low resource settings there are few services available to support children with cerebral palsy or their families. Research is required to understand the effectiveness of community and/or home based programmes to address this gap. This 2-year study aimed to evaluate a participatory caregiver training programme called ‘Getting to know cerebral palsy’ in Ghana. The training programme consisted of a monthly half-day support group with training, and a home visit, delivered across eight sites in Ghana over 10 months. A total of 76 families and children were included at baseline and 64 families followed up one year later at endline. Children were aged between 18months and 12 years with a mean of 3.8 years and a range of severity of cerebral palsy. Nearly all (97%) the caregivers were female and the father was absent in 51% of families. The study was a pre-post intervention design using mixed methods to evaluate the impact. A baseline and endline quantitative survey was conducted to assess caregiver quality of life (QoL) and knowledge about cerebral palsy and child feeding, health, and nutrition outcomes. Qualitative data was collected to explore the impact and experiences of the training programme in more depth".

DFID data disaggregation action plan - Better data for better lives

UK DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID)
UK AID
January 2017

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This action plan sets out the steps that the UK Department for International Development (DFID) will take to promote, provide and make use of their own development and humanitarian programme data which can be disaggregated on the basis of sex, age, disability status and geography (in the short term). It also has the objective to build the culture within DFID on disaggregated data, and to work with others to change the international development system on disaggregated data. A review is scheduled for 2020. Working with partners, influencing, capacity building and management information, research, analysis and reporting are outlined. Trailblazer country programmes with Bangladesh, Nepal, Zimbabwe and Rwanda are reported.

Mental health and trauma in asylum seekers landing in Sicily in 2015: a descriptive study of neglected invisible wounds

CREPET, Anna
RITA, Francesco
REID, Anthony
et al
January 2017

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While the medical conditions of newly migrated asylum seekers to Sicily were being addressed, the mental health of those who may have experienced trauma before, during, or after their migration was not addressed. "Médecins sans Frontières (MSF), in agreement with the Italian Ministry of Health, provided mental health (MH) assessment and care for recently-landed asylum seekers in Sicily. This study documents mental health conditions, potentially traumatic events and post-migratory living difficulties experienced by asylum seekers in the MSF programme in 2014–15." 

Partnerships in mental healthcare service delivery in low-resource settings: developing an innovative network in rural Nepal

ACHARYA, Bibhav
MARU, Duncan
SCHWARZ, Ryan
et al
January 2017

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"Mental illnesses are the largest contributors to the global burden of non-communicable diseases. However, there is extremely limited access to high quality, culturally-sensitive, and contextually-appropriate mental healthcare services. This situation persists despite the availability of interventions with proven efficacy to improve patient outcomes. A partnerships network is necessary for successful program adaptation and implementation."

Virtual knowledge center to end violence against women and girls

UNITED NATIONS ENTITY FOR GENDER EQUALITY AND THE EMPOWERMENT OF WOMEN
2017

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This Knowledge Centre is designed to serve the needs of policymakers, programme implementers and other practitioners dedicated to addressing violence against women and girls. It's primary purpose is to encourage and support evidence-based programming to more efficiently and effectively design, implement, monitor and evaluate initiatives to prevent and respond to violence against women and girls. To achieve this, the Global Virtual Knowledge Centre offers a ‘one stop’ service to users by making available the leading tools and evidence on what works to address violence against women and girls. It draws on expert recommendations, policy and programme evaluations and assessments, and fundamentally, on practitioners’ experiences from around the world

QualityRights materials for training, guidance and transformation

WHO
2017

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"As part of the QualityRights Initiative, WHO has developed a comprehensive package of training and guidance modules. The modules can be used to build capacity among mental health practitioners, people with psychosocial, intellectual and cognitive disabilities, people using mental health services, families, care partners and other supporters, NGOs, DPOs and others on how to implement a human rights and recovery approach in the area of mental health in line with the UN Convention on the Rights of Persons with Disabilities and other international human rights standards".

Equal measures 2030: Policymakers survey

EQUAL MEASURES 2030
2017

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This report gives interim findings from results of a survey of 109 policymakers in five countries (Indonesia, India, Kenya, Senegal and Colombia), and seeks to shed light on:

  • How do policymakers perceive progress on gender equality in their countries?
  • What most needs to change in order to improve gender equality?
  • What data and evidence do they rely on to make their decisions?
  • How confident are they in their understanding of the major challenges affecting girls and women in their countries?

 

These findings will contribute to debates about data-driven decision making on gender equality, and raise attention to the gaps in accessible, reliable and relevant data and evidence needed to reach the SDGs by 2030.

WHERE THERE IS NO REHAB PLAN A critique of the WHO scheme for Community Based Rehabilitation: with suggestions for future directions

MILES, M
2017

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Originally published at Mental Health Centre, Peshawar, 1985. Reprinted, 1997, Birmingham, UK, in revised format with minor corrections and updates. Online version, [2017 at ResearchGate],  with new introductory notes.

This paper examines with extensive documentation the theoretical and practical functioning and flaws of the WHO {World Health Organisation} Community Based Rehabilitation scheme currently  [i.e. 1985]  being field tested in a number of countries, and of the Manual Training Disabled People in the Community. The development of alternative CBR schemes in Asia, Africa and Latin America since the 1960s is outlined. It is demonstrated that the antithesis posited between 'Institution Based Rehabilitation' and 'Community Based Rehabilitation' is artificial, excluding as it does the middle ground of inexpensive, appropriate rehabilitation based at community-run neighbourhood centres. The strengths and weaknesses of neighbourhood centre based rehabilitation and the WHO‑style home‑based rehabilitation are compared, together with the many social, economic and demographic factors favouring the former approach. Cost considerations are examined in some detail. An account is given of experience in mobilising community resources for neighbourhood rehabilitation centres in Pakistan. Recommendations are made for future Community Rehabilitation plans, with emphasis on the development and dissemination of rehabilitation skills and information through appropriate media.

Toolkit for understanding and challenging leprosy related stigma for Civil Society Organisations in India

JOY, Anish
et al
2017

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This toolkit is intended primarily for use by CSO's at the community level in India for use with field workers and local governments for challenging stigma and discrimination against people affected by leprosy/disabilities. The toolkit uses simple activities and pictures and is based on a participatory approach which requires active involvement of the group being trained. There are 6 modules:

What is leprosy

What is stigma

How we stigmatise others

How it feels to be stigmatised

Understanding human rights

Action towards inclusion

There are 10 appendices providing supporting information for the toolkit  

Mad studies: Intersections with disability studies, social work, and mental health

INTERSECTIONALITIES, A GLOBAL JOURNAL OF SOCIAL WORK, ANALYSIS,RESEARCH, POLITY AND PRACTICE
December 2016

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A special issue of the online journal "Intersectionalities - A Global Journal of Social Work Analysis, Research, Polity, and Practice", Vol 5, No.3 (2016) providing 10 articles on the theme of Mad studies. Titles of papers included are: 

Doing Mad Studies: Making (Non)sense Together; 

An Introduction to Anti-Black Sanism; 

Why Mad Studies Needs Survivor Research and Survivor Research Needs Mad Studies; 

Recovery-as-Policy as a Form of Neoliberal State Making; 

“About Nothing Without Us”: A Comparative Analysis of Autonomous Organizing Among People Who Use Drugs and Psychiatrized Groups in Canada; 

Too Young to Be Mad: Disabling Encounters with 'Normal' from the Perspectives of Psychiatrized Youth; 

Relocating Mad_Trans Re_presentations Within an Intersectional Framework; 

A Desire to be ‘Normal’? A Discursive and Intersectional Analysis of ‘Penetration Disorder’; 

Racialized Communities, Producing Madness and Dangerousness; 

Psy-Times: The Psycho-Politics of Resilience in University Student Life

Report of the Special Rapporteur on the rights of persons with disabilities (theme: access to rights-based support for persons with disabilities)

DEVANDAS, Catalina
December 2016

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In her report, the Special Rapporteur provides an overview of the activities undertaken in 2016, as well as a thematic study on access to support by persons with disabilities. The study includes guidance for States on how to ensure the provision of different forms of rights-based support and assistance for persons with disabilities, in consultation with them. In preparing the study, the Special Rapporteur convened a regional expert consultation in Addis Ababa in September 2016 and analysed the responses to a questionnaire sent to Member States, national human rights institutions, agencies of the United Nations system, civil society organisations and persons with disabilities and their representative organisations. As at 5 December 2016, she had received 114 responses. 

Not forgetting severe mental disorders in humanitarian emergencies: a descriptive study from the Philippines

WEINTRAUB, Ana Cecilia Andrade de Moraes
et al
November 2016

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"In response to the Typhoon Haiyan in the Philippines, Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB) decided to concentrate its efforts in the severely affected area of Guiuan and its four surrounding municipalities. The MSF-OCB intervention included a comprehensive approach to mental health, including care for people with pre-existing and post-disaster severe mental disorders. Based on this experience of providing MH care in the first five months after Typhoon Haiyan, we report on the monthly volume of MH activities and beneficiaries; sociodemographic and care seeking characteristics of beneficiaries receiving MH counselling/care, stratified by the severity of their condition; profile and outcomes of patients with severe mental disorders; prescribing practice of psychotropic medication; and main factors facilitating the identification and management of individuals with severe mental disorders"

International Health, Vol.8, No.5, pp. 336-344

Doi: 10.1093/inthealth/ihw032

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.

The Use of the International Classification of Functioning, Disability and Health in Primary Care: Findings of Exploratory Implementation Throughout Life

PRINZIE, Peter
LEBEER, Jo
PRINZIE, Peter
2016

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Purpose:   The International Classification of Functioning (ICF) has found widespread acceptance since it was launched in 2001. Yet, little is known about its use in Primary Care. This paper aims to contribute to the dialogue about the practical use of the ICF by exploring how this framework constitutes a supplementary source to inform disability-related decision making in integrated Primary Care.

 

Method: The implementation process of the ICF in a Latin American Primary Care and Community-Based Rehabilitation setting is described and the ICF diagram is applied to a life story as an example of its current use. Participant observation, in-depth study of reports of team meetings and the review of clinical files are the main data collection methods. Data analysis is enabled by the combination of single-case study with theory testing, which facilitates the generation of hypotheses in this exploratory study.

 

Results: A valuable time component of the ICF may support continuity in Primary Care and the universal application of the ICF framework can promote comprehensiveness by integrating individual rehabilitation and collective disability prevention. A way to mitigate the perceived dominance of biomedical disease and deficiency thinking is proposed in order to encourage the biopsychosocial focus of Primary Care. Finally, the implementation of the International Classification of Diseases (ICD-10) in the health condition domain of the ICF highlights the importance of social responsibility towards disability.

 

Conclusion: This study suggests that a creative implementation of the ICF during life course to everyone who uses universally accessible healthcare may strengthen the integrative functions of Primary Care, and may be at the heart of the information system of this essential part of the healthcare system. Further research on the complementary use of ICF and ICD-10 is suggested in order to support community-based multisectoral intervention which may be coordinated by Primary Care.

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

The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery

ORLOWSKI, Simone
LAWN, Sharon
MATTHEWS, Ben
et al
October 2016

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Digital technologies show promise for reversing poor engagement of youth (16–24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. Results of in-depth qualitative data drawn from various stakeholders involved in provision of youth mental health services in one Australian rural region are described. Data were obtained using focus groups and semi-structured interviews with regional youth mental health clinicians, youth workers and support/management staff and analysed via inductive thematic analysis. Six main themes were identified: young people in a digital age, personal connection, power and vulnerability, professional identity, individual factors and organisational legitimacy. 

 

DOI: 10.1186/s12913-016-1790-y

Human rights toolkit for women and girls with disabilities. First edition.

Women With Disabilities Australia (WWDA)
October 2016

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A Toolkit for women or girls with disabilities to learn more about human rights and how this knowledge can be used to achieve change in their own lives or the lives of others. Following an introduction about why this Toolkit is needed,  a brief overview of five key human rights issues that women and girls with disability in Australia have identified as most important to them is provided. Section 3 provides information about what human rights are and also gives a brief overview about Australia’s international human rights obligations. Sections 4 and 5 focus on the Convention on the Rights of Persons with Disabilities (CRPD) and the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW), examining the main ‘Article’ from each, that deals with the important urgent issues that have been identified by women with disability in Australia, which are: Violence; Decision-Making; Participation; Sexual and Reproductive Rights; and, Employment. For each of these issues, the words of the main Article (as it appears in the CRPD and CEDAW) are provided and explained in practical terms, and examples are given of what governments have to know and do. Information from WWDA members and supporters about some of the key changes which need to happen is given. Different ideas of what women and girls with disability can do to help achieve change and promote the rights of all women and girls with disability are given and some sample letters and ‘talking points’ for phone calls to a local Member of Parliament, or a government Minister or advisers are provided.   

Being a refugee in Turkey and western Europe: how it affects mental health and psychosocial wellbeing

JOURNAL OF MENTAL AND PSYCHOSOCIAL SUPPORT IN CONFLICT AFFECTED AREAS
September 2016

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"In this personal reflection, the author is a Syrian refugee who describes his experiences as a psychosocial worker in Syria and with refugees in Turkey and Greece. He highlights how women and children lack safety in the camps. The second section discusses how he became a refugee himself. Due to his experiences in Syria, he now finds himself in a difficult situation in the Netherlands, the county where he applied for asylum and has received a permit, but his ‘cry for help’ remains unheard and unrecognised by the (health) workers in the asylum centre."

Mental health and psychosocial support for South Sudanese refugees in northern Uganda: a needs and resource assessment

ADAKU, Alex
et al
September 2016

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Since December 2013, an armed conflict in South Sudan has resulted in the displacement of over 2.2 million people, more than 270,000 of whom were, at the time of the research, in refugee settlements located throughout Uganda. A mental health and psychosocial support (MHPSS)​MHPSS needs and resource assessment was carried out in Rhino Camp refugee settlement in northern Uganda, between June and August 2014 following World Health Organization (WHO) and United Nations High Commissioner for Refugees (UNHCR) guidelines for MHPSS needs assessments in humanitarian settings. The assessment used a range of methodologies including: 1) a desk (literature) review to understand the context for mental health service provision; 2) an analysis of data from existing health information systems (HIS); 3) an assessment of the current infrastructure for service provision using a shortened version of a Who does What Where until When (4Ws); and 4) semi-structured individual and group interviews (total n = 86) with key informants (n = 13) and general community members (individual interviews n = 28, four focus groups with n = 45).

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