Setting Up Community Mental Health

Abstract

The evidence of significantly elevated levels of mental and substance use disorders in Low Middle Income Countries (LMICs) is a threat to the psycho-socio-economic wellbeing of many individuals. Mental disorders impair productivity and are a cause of disability. The negative effects of mental disorders are not only felt by the person living with the condition but also the care givers and the community at large. It is therefore imperative to device a feasible way of combating this problem at the family and community level. Unfortunately, the huge shortage of mental health experts in LMICs is a hindrance in the provision of community mental health services. This is further complicated by stigma and lack of awareness which leads to injustices and discrimination. Additionally, the myths and misconception on mental disorders in Africa is an obstacle to early diagnosis and prevents access to timely appropriate treatment. Despite these challenges, there still exists opportunities through which mental health care can be enhanced in the low resource settings. This can be made possible by mapping of the available resources and gathering evidence of their practical utility in order to develop a sustainable and culturally acceptable mental health care system in the community. Africa and other LMICs may not attain the acceptable ratio of mental health experts per the population in the foreseeable near future based on the current trend in the health care system. Therefore, it may be pointless to major on the conversations depicting the increase in number of mental health experts as the only remedy to the existing treatment gap. On the contrary, identification of strengths and building on the existing infrastructure would be critical in changing the narrative of mental health monopoly by experts. The already available community resources include the community health workers, primary health care workers (nurses and clinical officers), traditional healers, and even faith healers.

Studies undertaken in different under-resourced settings demonstrate outstanding innovations inspired by the existing mental health treatment gap and the increasing disease burden. Such studies have highlighted the feasibility of utilizing nonspecialists at primary health care level to provide mental health interventions through task sharing and task shifting approaches. In addition, some researchers have highlighted that the engagement of informal health care providers can have significant positive results in improving access to community mental health services. Therefore, recommendations and lessons learnt from different study projects from poor resource settings should be effectively implemented. This should take into account the context-specific challenges and community contributions to the mental health care program.