Intégration de la santé mentale dans les services de soins de santé primaires en République démocratique du Congo

Mayoyo, Erick Mukala; Put, Willem van de; Belle, Sara Van; Mierlo, B. van; Criel, Bart

doi:10.3917/spub.211.0077

Cited by 7 publications

(12 citation statements)

References 24 publications

(24 reference statements)

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“…It should follow the correct strategy of providers and nonproviders of care, (ii) ensure that primary mental health care also includes brief psychotherapeutic interventions, (iii) promote recovery-oriented community interventions for people with chronic disabling mental disorders, (iv) conceptualize training as a continuous process of strengthening clinical skills through supervision, (v) involve community partners in psychosocial interventions, (vi) integrate changes toward primary mental health care into broader health policy reforms, and (vii) promote intersectoral approaches to address the social determinants of mental health. Most of these recommendations are feasible in the Congolese context since they have been successfully tested in the health district of Lubero in the eastern region of the DRC [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the country has only 6 public psychiatric hospitals and a dozen private mental health centers with 500 beds for nearly 90 million inhabitants, almost all of which are in located cities [ 23 ]. The coverage of mental health services remains very low (less than 5%); however, mental health provision is severely lacking in primary care services nationwide [ 24 ], and only 3% of PHC services have been able to integrate mental health care supply into their activity packages [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…At the PHC level, no protocols for the care and assessment of mental health problems or official referral and counterreferral systems between PHC and mental health providers exist [ 24 ]. A 2006 report by the WHO together with the Congolese Ministry of Health shows that at most, 1 in 10 patients with a mental health condition attending PHC are referred to a mental health professional [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of Tshamilemba

et al. 2023

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Background Integrating mental health care into the primary care system is an important policy option in the Democratic Republic of the Congo (DRC). From the perspective of the integration of mental health care in district health services, this study analyzed the existing demand and supply of mental health care in the health district of Tshamilemba, which is located in Lubumbashi, the second largest city of the DRC. We critically examined the district’s operational response capacity to address mental health. Methods A multimethod cross-sectional exploratory study was carried out. We conducted a documentary review (including an analysis of the routine health information system) from the health district of Tshamilemba. We further organized a household survey to which 591 residents responded and conducted 5 focus group discussions (FGDs) with 50 key stakeholders (doctors, nurses, managers, community health workers and leaders, health care users). The demand for mental health care was analyzed through the assessment of the burden of mental health problems and care-seeking behaviors. The burden of mental disorders was assessed by calculating a morbidity indicator (proportion of mental health cases) and through a qualitative analysis of the psychosocial consequences as perceived by the participants. Care-seeking behavior was analyzed by calculating health service utilization indicators and more specifically the relative frequency of mental health complaints in primary health care centers, and by analyzing FGDs participants’ reports. The mental health care supply available was described by using the qualitative analysis of the declarations of the participants (providers and users of care) to the FGDs and by analyzing the package of care available in the primary health care centers. Finally, the district’s operational response capacity was assessed by making an inventory of all available resources and by analyzing qualitative data provided by health providers and managers regarding the district’ capacity to address mental health conditions. Results Analysis of technical documents indicated that the burden of mental health problems is a major public problem in Lubumbashi. However, the proportion of mental health cases among the general patient population seen in the outpatient curative consultations in the Tshamilemba district remains very low, at an estimated 5.3%. The interviews not only pointed to a clear demand for mental health care but also indicated that there is currently hardly any offer of care available in the district. There are no dedicated psychiatric beds, nor is there a psychiatrist or psychologist available. Participants in the FGDs stated that in this context, the main source of care for people remains traditional medicine. Conclusion Our findings show a clear demand for mental health care and a lack of formal mental health care supply in the Tshamilemba district. Moreover, this district lacks adequate operational capacity to meet the mental health needs of the population. Traditional African medicine is currently the main source of mental health care in this health district. Identifying concrete priority mental health actions to address this gap, by making evidence-based mental care available, is therefore of great relevance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of Tshamilemba

et al. 2023

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“…However, a study in Tshopo Province in the DRC indicated that community health workers provide health care, including mental health care, suggesting that task-shifting would work in their favor [31]. The rst experience with mental health integration in the North Kivu province in the DRC showed that community health workers contributed signi cantly to mental health promotion through awareness-raising, community mobilization, follow-up of patients during home visits, and more [13].…”

Section: Discussionmentioning

confidence: 99%

“…In the DRC, given that the coverage of mental health services is estimated at a dismal 5% [13], traditional medicine remains the main source of care for the population in both urban and rural areas [14].…”

Section: Introductionmentioning

confidence: 99%

Understanding the mix of services for mental health care in urban DR Congo: A qualitative descriptive study

Mayoyo

Criel

Sow

et al. 2023

Preprint

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Background: Mental health workers (MHWs) may be exposed to conflicts of competencies in performing tasks related to mental health care provision. This may be linked to a lack of understanding of their tasks as caregivers and providers. Furthermore, in most low-income settings, it is unclear how the available services are organized and coordinated to provide mental health care. To understand the above, this study aimed to identify the current mix of services for mental health care in urban Democratic Republic of the Congo (DRC). Methods: A qualitative descriptive study was carried out in the city of Lubumbashi from February to April 2021. We conducted 7 focus group discussions (FGDs) with 74 key informants (family members, primary care physicians, etc.) and 13 in-depth interviews (IDIs) with key informants (traditional healers, psychiatrists, etc.). We performed a qualitative content analysis, guided by an analytical framework, that led to the development of a comprehensive inventory of MHWs from the household level to specialized facilities, exploring their tasks in care delivery, identifying existing services, and defining their current organization. Results: Analysis of transcripts from the FGDs and IDIs showed that traditional healers and family caregivers are the main providers in Lubumbashi. The exploration of the tasks performed by MHWs revealed that lifestyle, traditional therapies, psychotherapy and medication are the main types of care offered/advised to patients. Active informal caregivers do not currently provide care corresponding to their competencies. The rare mental health specialists available do not presently recognize the tasks of primary care providers and informal caregivers in care delivery, and their contribution is considered marginal. We identified five types of services: informal services, traditional therapy services, social services, primary care services, and psychiatric facilities. Analyses pointed out an inversion of the ideal mix of these services. Conclusions: Our findings show a suboptimal mix of services for mental health and point to a clear lack of collaboration between MHWs. There is an urgent need to clearly define the tasks of MHWs, build the capacity of nonspecialists, shift mental health-related tasks to them and raise awareness about collaborative care approaches.

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Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo

Ngamaba,

Lombo,

Makopa

et al. 2024

npj Mental Health Res

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In the Democratic Republic of the Congo (DRC), the prevalence of mental health issues could be greater than in other low-income and middle-income countries because of major risk factors related to armed conflicts and poverty. Given that mental health is an essential component of health, it is surprising that no systematic evaluation of mental health in the DRC has yet been undertaken. This study aims to undertake the first systematic review of mental health literacy and service provision in the DRC, to bridge this gap and inform those who need to develop an evidence base. This could support policymakers in tackling the issues related to limited mental health systems and service provision in DRC. Following Cochrane and PRISMA guidelines, a systematic (Web of Science, Medline, Public Health, PsycINFO, and Google Scholar) search was conducted (January 2000 and August 2023). Combinations of key blocks of terms were used in the search such as DRC, war zone, mental health, post-traumatic stress disorder (PTSD), anxiety, depression, sexual violence, war trauma, resilience, mental health systems and service provision. We followed additional sources from reference lists of included studies. Screening was completed in two stages: title and abstract search, and full-text screening for relevance and quality. Overall, 50 studies were included in the review; the majority of studies (n = 31) were conducted in the Eastern region of the DRC, a region devastated by war and sexual violence. Different instruments were used to measure participants’ mental health such as the Hopkins Symptoms Checklist (HSCL-25), The Harvard Trauma Questionnaire, Patient Health Questionnaire (PHQ-9); General Anxiety Disorder (GAD-7), and Positive and Negative Symptoms Scale (PANSS). Our study found that wartime sexual violence and extreme poverty are highly traumatic, and cause multiple, long-term mental health difficulties. We found that depression, anxiety, and PTSD were the most common problems in the DRC. Psychosocial interventions such as group therapy, family support, and socio-economic support were effective in reducing anxiety, depression, and PTSD symptoms. This systematic review calls attention to the need to support sexual violence survivors and many other Congolese people affected by traumatic events. This review also highlights the need for validating culturally appropriate measures, and the need for well-designed controlled intervention studies in low-income settings such as the DRC. Better public mental health systems and service provision could help to improve community cohesion, human resilience, and mental wellbeing. There is also an urgent need to address wider social issues such as poverty, stigma, and gender inequality in the DRC.

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Intégration de la santé mentale dans les services de soins de santé primaires en République démocratique du Congo

Cited by 7 publications

References 24 publications

Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of Tshamilemba

Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of Tshamilemba

Understanding the mix of services for mental health care in urban DR Congo: A qualitative descriptive study

Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo

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