Sitting with others: mental health self-help groups in northern Ghana.

BACKGROUND: Over the past four decades, there has been increasing interest in Self-Help Groups, by mental health services users and caregivers, alike. Research in high-income countries suggests that participation in SHGs is associated with decreased use of inpatient facilities, improved social functioning among service users, and decreased caregiver burden. The formation of SHGs has become an important component of mental health programmes operated by non-governmental organisations (NGOs) in low-income countries. However, there has been relatively little research examining the benefits of SHGs in this context. METHODS: Qualitative research with 18 SHGs, five local non-governmental organisations, community mental health nurses, administrators in Ghana Health Services, and discussions with BasicNeeds staff. RESULTS: SHGs have the potential to serve as key components of community mental health programmes in low-resource settings. The strongest evidence concerns how SHGs provide a range of supports, e.g., social, financial, and practical, to service users and caregivers. The groups also appear to foster greater acceptance of service users by their families and by communities at large. Membership in SHGs appears to be associated with more consistent treatment and better outcomes for those who are ill. DISCUSSION: This study highlights the need for longitudinal qualitative and quantitative evaluations of the effect of SHGs on clinical, social and economic outcomes of service users and their carers. CONCLUSIONS: The organisation of SHGs appears to be associated with positive outcomes for service users and caregivers. However, there is a need to better understand how SHGs operate and the challenges they face.

Success indicators for integrating mental health interventions with community-based rehabilitation projects.

Community interventions for people with physical disabilities and for people with mental illness have evolved following similar trajectories, although at different periods of time. This study develops and tests indicators for successful integration of community-based rehabilitation (CBR)-mental health and development (MHD) services. An in-depth study was conducted of two organizations in Sri Lanka and India that successfully integrated CBR and MHD services as well as two organizations in Nepal and Bangladesh, which were planning integration. Interviews and focus groups were used to gather nonconfidential information. The study suggests many benefits of integration and several indicators of readiness: willingness to work with mentally ill people, a basic understanding of the mental health concept and mental illness problems, a match of context and strategy between current CBR activities and proposed MHD activities, stability of basic resources and infrastructure in the organization. A second set of indicators determined the long-term viability of an integrated CBR-MHD approach: ability to strategize and plan a mental health programme, ability to network with stakeholders effectively, ability to make use of resources efficiently. A major finding of the study was the need for training in the practical aspects of integration of mental health interventions with CBR. Tool sets are available that can be used by donors and by local organizations for assessing needs and readiness as well as developing viable strategies for the integration of community-based mental health interventions into existing CBR work.

Barriers to improvement of mental health services in low-income and middle-income countries.

Despite the publication of high-profile reports and promising activities in several countries, progress in mental health service development has been slow in most low-income and middle-income countries. We reviewed barriers to mental health service development through a qualitative survey of international mental health experts and leaders. Barriers include the prevailing public-health priority agenda and its effect on funding; the complexity of and resistance to decentralisation of mental health services; challenges to implementation of mental health care in primary-care settings; the low numbers and few types of workers who are trained and supervised in mental health care; and the frequent scarcity of public-health perspectives in mental health leadership. Many of the barriers to progress in improvement of mental health services can be overcome by generation of political will for the organisation of accessible and humane mental health care. Advocates for people with mental disorders will need to clarify and collaborate on their messages. Resistance to decentralisation of resources must be overcome, especially in many mental health professionals and hospital workers. Mental health investments in primary care are important but are unlikely to be sustained unless they are preceded or accompanied by the development of community mental health services, to allow for training, supervision, and continuous support for primary care workers. Mobilisation and recognition of non-formal resources in the community must be stepped up. Community members without formal professional training and people who have mental disorders and their family members, need to partake in advocacy and service delivery. Population-wide progress in access to humane mental health care will depend on substantially more attention to politics, leadership, planning, advocacy, and participation.