RESUMEN
For the past years, Ecuador has been transitioning away from a hospital-based model of mental healthcare to one that is community-centred. However, challenges associated with hospital-based models endure, notably financial burden faced by those with severe mental health problems (SMHPs) due to labour market discrimination. Employment access for this group is often disregarded in policy planning, despite evidence of its benefits on mental health. Huertomanías, an urban garden initiative in Ecuador founded in 2015, works with individuals with SMHPs, providing work, income, and social inclusion. A case study using a participatory approach was carried out to explore factors that impact the recovery of people with SMHPs. Twelve participants engaged in diverse stages of the research, where several participatory activities were conducted including cognitive mapping, a photovoice project, and interviews. The analysis employed a thematic approach leading to four categories of impact within the urban garden: autonomy (financial and personal), interpersonal relations and relation with the environment, mental health, and family dynamics. A final category of impact was established encompassing external factors (family support and public policy and healthcare services) that influence recovery. Findings suggest that the urban garden promotes autonomy and active participation within society, improves mental health, and transforms family dynamics. Further, this study highlights the importance of community-based mental healthcare (CBMHC), emphasising the need of public policies and healthcare in promoting autonomy through employment and community-centred services. Lastly, the study contributes insights into recovery experiences and CBMHC benefits, informing programme development and similar initiatives in Latin America.
RESUMEN
Community-based mental health initiatives are uniquely positioned to understand the mental health needs of their local population and provide relevant, culturally appropriate and sustainable responses. However, at the grassroots level, mental health initiatives in low- and middle-income countries face key challenges, such as inadequate funding, barriers to demonstrating impact and difficulty engaging with stakeholders. The Ember Mental Health programme establishes 12-month partnerships with community-based mental health initiatives in low- and middle-income countries to support them to address these challenges, grow and achieve sustainability. This paper outlines a longitudinal qualitative study conducted to evaluate the 2020-2021 Ember Mental Health programme. Data were collected from March 2020 to March 2021 through semistructured interviews conducted with 11 initiatives at various time points throughout their Ember Mental Health partnership. A framework approach was used to analyse all data in its original language. Findings indicated that initiatives particularly benefited from provision of side-by-side mentorship; opportunities for skills strengthening and strategic thinking; occasions to network with other like-minded initiatives and/or experts in global mental health; and support on team empowerment and well-being. Based on these findings, we put forward various recommendations for funders and other stakeholders working to support community-based mental health initiatives in low- and middle-income countries. Through establishing collaborative partnerships that challenge more top-down, traditional funder-grantee relationships, it is possible to support the rich ecosystem of initiatives working to address the mental health needs of communities.
