BackgroundOver 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.MethodsQualitative research with 18 SHGs, five local non-governmental organisations, community mental health nurses, administrators in Ghana Health Services, and discussions with BasicNeeds staff.ResultsSHGs 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.DiscussionThis 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.ConclusionsThe 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.
As one article in a series on Global Mental Health Practice, Shoba Raja and colleagues provide a case study of BasicNeeds in Nepal, which emphases user empowerment, community development, health systems strengthening, and policy change to help socially disadvantaged individuals with mental health conditions.
Mental health services in the Eastern Mediterranean Region are predominantly centralized and institutionalized, relying on scarce specialist manpower. This creates a major treatment gap for patients with common and disabling mental disorders and places an unnecessary burden on the individual, their family and society. Six steps for reorganization of mental health services in the Region can be outlined: (1) integrate delivery of interventions for priority mental disorders into primary health care and existing priority programmes; (2) systematically strengthen the capacity of non-specialized health personnel for providing mental health care; (3) scale up community-based services (community outreach teams for defined catchment, supported residential facilities, supported employment and family support); (4) establish mental health services in general hospitals for outpatient and acute inpatient care; (5) progressively reduce the number of long-stay beds in mental hospitals through restricting new admissions; and (6) provide transitional/bridge funding over a period of time to scale up community-based services and downsize mental institutions in parallel.
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.
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