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

Abstract

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.

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

“…Behavioural problems were associated with socioeconomic features only 3 34. Mukala, Mayolo E. 2023 41 Lubumbashi, DRC 591 residents responded and conducted 5 focus groups with 50 key stakeholders (doctors, nurses, managers, community health workers. and leaders, health care users) Integrating mental health care into the primary care system.…”

“…There are very few hospitals for the treatment of mental health disorders in DRC. The country has only six public psychiatric hospitals, and a dozen private mental health centres with 500 beds for nearly 90 million inhabitants, almost all of which are in big cities 41 , 42 .…”

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

“…At the personal and household level, we found that the general population does not have the needed skills for self-care in case of mental health problems. At the community level, where stigmatization prevails [14], people with unmet mental health needs resort essentially to spiritual and traditional healers, as there are no community-based organizations, no school-based services, no youth clubs, no user associations, etc., taking care of mental health patients. At the primary care level, we found that no health centers or district hospitals are currently offering mental health care.…”

“…In LMICs, where social protection is limited, nancial support from the family is of great relevance. Because stigmatizing attitudes toward patients with mental disorders are highly visible in urban areas of the DRC [14], family caregivers of patients with mental illness may also be exposed to stigma. Among the strategies to reduce stigma for family caregivers, i.e., improving mental health literacy, education and coping strategies, promoting well-being, etc.…”

“…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].…”