Development of a scalable mental healthcare plan for a rural district in Ethiopia

Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W.; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick

doi:10.1192/bjp.bp.114.153676

Cited by 104 publications

(167 citation statements)

References 22 publications

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“…In high-income countries, screening for depression and suicidal ideation and treatment of depression are evidence-based risk reduction strategies (Fleischmann et al , 2016, Mann et al , 2005). Moreover, primary care health facilities increasingly are a setting for mental health care in LMIC (Fekadu et al , 2016, Jordans et al , 2016, Kigozi et al , 2015, Lund et al , 2015, Petersen et al , 2016, Shidhaye et al , 2016). …”

Section: Discussionmentioning

confidence: 99%

Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

Jordans

Rathod

Fekadu

et al. 2017

Epidemiol Psychiatr Sci

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The high prevalence of suicidal ideation in primary care points towards important opportunities to implement suicide risk reduction initiatives. Evidence-supported strategies including screening and treatment of depression in primary care can be implemented through the World Health Organization's mental health Global Action Programme suicide prevention and depression treatment guidelines. Suicidal ideation and behaviours in the community sample will require detection strategies to identify at risks persons not presenting to health facilities.

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Section: Discussionmentioning

confidence: 99%

Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

Jordans

Rathod

Fekadu

et al. 2017

Epidemiol Psychiatr Sci

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“…PRIME Ethiopia is currently implementing a programme of care for people with epilepsy, psychosis, bipolar disorder, depression and alcohol use disorders integrated into primary health care in the Sodo district of Ethiopia [24]. Sodo district is located in the Gurage Zone, 100 km south of the capital city, Addis Ababa, with a population of 161,952 people at the time of the 2013 census [25].…”

Section: Methodsmentioning

confidence: 99%

Help seeking and suicidality among people with epilepsy in a rural low income country setting: cross-sectional survey

Tsigebrhan

Hanlon

Medhin

et al. 2017

Int J Ment Health Syst

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BackgroundsEpilepsy is a serious neurological disorder associated with a high level of psychiatric comorbidity. Suicidality is a recognised complication of epilepsy. As part of developing an integrated service for people with epilepsy (PWE) and priority psychiatric disorders within primary care, a cross-sectional study was conducted in a rural district in Ethiopia to investigate patterns of help-seeking, suicidality and the association with duration of untreated epilepsy (DUE) among PWE.MethodsCases were identified through community key informants and diagnosis was confirmed by trained primary care clinicians. Severity of epilepsy, depression and suicidality were assessed using standardised methods. Multivariable regression analysis was used to test the hypothesis that suicidality was associated with DUE.ResultsThe majority of PWE sought help from both religious and biomedical healing centres. The lifetime treatment gap for biomedical care was 26.9%, with a 12 month treatment gap of 56.7%. Close to one-third (29.9%) of participants reported using traditional and cultural healing practices. Nearly one-third (30.2%) of participants reported suicidality (suicidal ideation, plan or attempt) in the previous 1 year. The median (IQR) DUE was 24 months (4–72). There was no association between DUE and suicidality. In the multivariable model, being married [odds ratio (OR) 2.81, 95% CI 1.22, 6.46], increased depressive symptoms (OR 1.17, 95% CI 1.10, 1.26) and perceived poorer wealth relative to others (OR 2.67, 95% CI 1.07, 6.68) were associated independently with suicidality.ConclusionIn this study, PWE sought help from both biomedical and religious healing centres. Suicidality and depression have a high prevalence in PWE in this setting. Integrated mental and neurological health care within primary care is needed for improved holistic management of epilepsy.

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“…Research-led programmes to implement and evaluate integrated mental health care are also underway in Ethiopia, including the Programme for Improving Mental health carE (PRIME) [28, 29], the Africa Focus on Intervention Research for Mental Health (AFFIRM) [30] and the ‘Emerging mental health systems in LMICs’ (Emerald) programme [31]. …”

Section: Introductionmentioning

confidence: 99%

Health system governance to support scale up of mental health care in Ethiopia: a qualitative study

Hanlon

Eshetu

Alemayehu

et al. 2017

Int J Ment Health Syst

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BackgroundEthiopia is embarking upon a ground-breaking plan to address the high levels of unmet need for mental health care by scaling up mental health care integrated within primary care. Health system governance is expected to impact critically upon the success or otherwise of this important initiative. The objective of the study was to explore the barriers, facilitators and potential strategies to promote good health system governance in relation to scale-up of mental health care in Ethiopia.MethodsA qualitative study was conducted using in-depth interviews. Key informants were selected purposively from national and regional level policy-makers, planners and service developers (n = 7) and district health office administrators and facility heads (n = 10) from a district in southern Ethiopia where a demonstration project to integrate mental health into primary care is underway. Topic guide development and analysis of transcripts were guided by an established framework for assessing health system governance, adapted for the Ethiopian context.ResultsFrom the perspective of respondents, particular strengths of health system governance in Ethiopia included the presence of high level government support, the existence of a National Mental Health Strategy and the focus on integration of mental health care into primary care to improve the responsiveness of the health system. However, both national and district level respondents expressed concerns about low baseline awareness about mental health care planning, the presence of stigmatising attitudes, the level of transparency about planning decisions, limited leadership for mental health, lack of co-ordination of mental health planning, unreliable supplies of medication, inadequate health management information system indicators for monitoring implementation, unsustainable models for specialist mental health professional involvement in supervision and mentoring of primary care staff, lack of community mobilisation for mental health and low levels of empowerment and knowledge undermining meaningful involvement of stakeholders in local mental health care planning.ConclusionsTo support scale-up of mental health care in Ethiopia, there is a critical need to strengthen leadership and co-ordination at the national, regional, zonal and district levels, expand indicators for routine monitoring of mental healthcare, promote service user involvement and address widespread stigma and low mental health awareness.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-017-0144-4) contains supplementary material, which is available to authorized users.

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Development of a scalable mental healthcare plan for a rural district in Ethiopia

Cited by 104 publications

References 22 publications

Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

Suicidal ideation and behaviour among community and health care seeking populations in five low- and middle-income countries: a cross-sectional study

Help seeking and suicidality among people with epilepsy in a rural low income country setting: cross-sectional survey

Health system governance to support scale up of mental health care in Ethiopia: a qualitative study

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