Teenage pregnancy rates in Uganda are among the highest in sub-Saharan Africa. Child marriage is often the result of unmarried teenage pregnancy and is recognised by Uganda's government as a form of sexual violence and an outcome of inequality. However, unmarried motherhood incurs stigma and shame within traditionally living rural communities. Using co-produced Open Space and ethnographic methods, we examined the psychosocial impact of unmarried motherhood on girls and their communities, and explored problem-solving with key local stakeholders. Findings indicate that girls experience extreme stress, social exclusion and rejection by their families, and experience bereavement from school expulsion and the loss of their career aspirations. Depressive symptoms and suicidal behaviour are reportedly not uncommon among this population group. Community and family efforts to promote marriage for these mothers to avoid social stigma increased the mothers’ feelings of depression, whereas mothers who became independent appeared to fare better psychologically. Community members and local stakeholders demonstrated a willingness to act locally to reduce the negative impacts of unmarried motherhood but lacked knowledge and support resources. Our findings indicate that mental health promotion for teenage mothers is likely to be better served through empowerment strategies rather than marriage and, in a context of poor mental health service access, there is a substantial role for community mobilisation and the promotion of self-help strategies to support teenage mothers. This study raises important points regarding different community understandings of depression and indicates collaboration between professionals and communities for a values-based approach.
Evidence suggests that substance misuse service practitioners attempt to work with dual diagnosis patients but lack the skills and knowledge to address both health problems. This study explores the impact of placing a mental health consultant within a substance misuse community team on knowledge, confidence and willingness to work with dual diagnosis patients. A participant action research method was used to explore the role and effect of the mental health consultant on the effectiveness of the practitioners' work with dual diagnosis patients. The presence of the mental health specialist demonstrated increased confidence, willingness and ability to work effectively with dual diagnosis patients accessing the service. The conditions required for success for this type of service provision is discussed. The accessibility of the consultant via clinical supervision and training impacted on the confidence of the practitioners and increased the level of complexity at which the practitioners were prepared to work with this client group. It is suggested that this supervisory role could model approaches to joint-working between mental health and substance misuse services for better management of dual diagnosis patients.
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