Integrating Mental Health and Development: A Case Study of the BasicNeeds Model in Nepal

Raja, Shoba; Underhill, Chris; Shrestha, Padam; Sunder, Uma; Mannarath, Saju; Wood, Sarah; Patel, Vikram

doi:10.1371/journal.pmed.1001261

Cited by 49 publications

(55 citation statements)

References 10 publications

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“…Stigma and poverty were highlighted by participants as the major barriers. Mental health stigma in the communities and within health systems is prevalent across countries and cultures that hinders the mental health system strengthening process and impedes recovery of mental illness (Saraceno et al 2007;Evans-Lacko et al 2012;Clement et al 2015;Lewer et al 2015). This study shows that stigma is also the major barrier to service user and caregiver participation.…”

Section: Discussionmentioning

confidence: 66%

Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study

Lempp

Abayneh

Gurung³

et al. 2017

Epidemiol Psychiatr Sci

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Aims.The aims of this paper are to: (i) explore the experiences of involvement of mental health service users, their caregivers, mental health centre heads and policy makers in mental health system strengthening in three low- and middle-income countries (LMICs) (Ethiopia, Nepal and Nigeria); (ii) analyse the potential benefits and barriers of such involvement; and (iii) identify strategies required to achieve greater service user and caregiver participation.Methods.A cross-country qualitative study was conducted, interviewing 83 stakeholders of mental health services.Results.Our analysis showed that service user and caregiver involvement in the health system strengthening process was an alien concept for most participants. They reported very limited access to direct participation. Stigma and poverty were described as the main barriers for involvement. Several strategies were identified by participants to overcome existing hurdles to facilitate service user and caregiver involvement in the mental health system strengthening process, such as support to access treatment, mental health promotion and empowerment of service users. This study suggests that capacity building for service users, and strengthening of user groups would equip them to contribute meaningfully to policy development from informed perspectives.Conclusion.Involvement of service users and their caregivers in mental health decision-making is still in its infancy in LMICs. Effective strategies are required to overcome existing barriers, for example making funding more widely available for Ph.D. studies in participatory research with service users and caregivers to develop, implement and evaluate approaches to involvement that are locally and culturally acceptable in LMICs.

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Section: Discussionmentioning

confidence: 66%

Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study

Lempp

Abayneh

Gurung³

et al. 2017

Epidemiol Psychiatr Sci

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show abstract

“…The integration of mental health services into primary health care needs to consider the social, economic and educational status of service users, as well as the stigmatizing and discriminatory practices that tend to disempower and marginalize service user and caregiver involvement [48, 49]. There is emerging evidence that interventions to improve access to mental health care combined with promoting livelihoods and peer support (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…In low- and -middle income countries (LMICs), service user and caregiver involvement has been proposed as an essential means of strengthening weak mental health care systems [8], to protect and promote service user rights and ensure successful scale up of quality mental health care [9–11]. In LMICs, service user and caregiver contributions to the mental health system have received minimal attention.…”

Section: Introductionmentioning

confidence: 99%

Service user involvement in mental health system strengthening in a rural African setting: qualitative study

Abayneh¹,

Lempp

Alem³

et al. 2017

BMC Psychiatry

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BackgroundIt is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach.MethodsThirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied.ResultsAll groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions.ConclusionAs Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1352-9) contains supplementary material, which is available to authorized users.

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“…Full social participation for vulnerable groups requires sustained access to jobs, schools, and other services; this requires cooperation among education, social services, labor, and justice sectors [21],[24].These efforts can be tailored to available resources; in small villages of Rio Negro Province, Argentina, intersectoral collaboration occurs when mental health professionals collaborate with justice officials to intervene in cases of domestic violence or to train and equip local police staff to recognize acute psychiatric problems and to facilitate home-based care [25]. NGOs often facilitate integrated delivery of mental health and social services in community settings [26],[27] (see Box 1). …”

Section: The Grand Challenge Of Integrating Care For Mns Disorders Wimentioning

confidence: 99%

Grand Challenges in Global Mental Health: Integration in Research, Policy, and Practice

et al. 2013

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Integrating Mental Health and Development: A Case Study of the BasicNeeds Model in Nepal

Cited by 49 publications

References 10 publications

Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study

Service user and caregiver involvement in mental health system strengthening in low- and middle-income countries: a cross-country qualitative study

Service user involvement in mental health system strengthening in a rural African setting: qualitative study

Grand Challenges in Global Mental Health: Integration in Research, Policy, and Practice

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