Mental health practitioners' reflections on psychological work in Uganda: exploring perspectives from different professions

Hall, Jennifer; Dardenne, P; Nsereko, James; Kasujja, Rosco; Baillie, Dave; Mpango, Richard; Birabwa, Harriet; Hunter, Elaine

doi:10.1080/03069885.2014.886672

Cited by 12 publications

(11 citation statements)

References 10 publications

(9 reference statements)

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“…Uganda’s mental health system, much like those in other low-income countries, lacks the resources necessary to consistently provide effective treatment across the country, with only 2.96 mental health workers (including just 0.09 psychiatrists and 2.24 mental health nurses) per 100,000 people [88]. With pharmaceutical treatment availability concentrated in urban areas and typically limited to older, cheaper, and less effective medications, participants in this study may have perceived mental health treatment to be largely ineffective or inaccessible [76,77,89]. These perceptions may have attenuated the effect that providing them with treatment information could have had on stigmatizing beliefs elicited in the survey [90].…”

Section: Discussionmentioning

confidence: 99%

Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda

et al. 2019

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BackgroundMental illness stigma is a fundamental barrier to improving mental health worldwide, but little is known about how to durably reduce it. Understanding of mental illness as a treatable medical condition may influence stigmatizing beliefs, but available evidence to inform this hypothesis has been derived solely from high-income countries. We embedded a randomized survey experiment within a whole-population cohort study in rural southwestern Uganda to assess the extent to which portrayals of mental illness treatment effectiveness influence personal beliefs and perceived norms about mental illness and about persons with mental illness.Methods and findingsStudy participants were randomly assigned to receive a vignette describing a typical woman (control condition) or one of nine variants describing a different symptom presentation (suggestive of schizophrenia, bipolar, or major depression) and treatment course (no treatment, treatment with remission, or treatment with remission followed by subsequent relapse). Participants then answered questions about personal beliefs and perceived norms in three domains of stigma: willingness to have the woman marry into their family, belief that she is receiving divine punishment, and belief that she brings shame on her family. We used multivariable Poisson and ordered logit regression models to estimate the causal effect of vignette treatment assignment on each stigma-related outcome. Of the participants randomized, 1,355 were successfully interviewed (76%) from November 2016 to June 2018. Roughly half of respondents were women (56%), half had completed primary school (57%), and two-thirds were married or cohabiting (64%). The mean age was 42 years. Across all types of mental illness and treatment scenarios, relative to the control vignette (22%–30%), substantially more study participants believed the woman in the vignette was receiving divine punishment (31%–54%) or believed she brought shame on her family (51%–73%), and most were unwilling to have her marry into their families (80%–88%). In multivariable Poisson regression models, vignette portrayals of untreated mental illness, relative to the control condition, increased the risk that study participants endorsed stigmatizing personal beliefs about mental illness and about persons with mental illness, irrespective of mental illness type (adjusted risk ratios [ARRs] varied from 1.7–3.1, all p < 0.001). Portrayals of effectively treated mental illness or treatment followed by subsequent relapse also increased the risk of responses indicating stigmatizing personal beliefs relative to control (ARRs varied from 1.5–3.0, all p < 0.001). The magnitudes of the estimates suggested that portrayals of initially effective treatment (whether followed by relapse or not) had little moderating influence on stigmatizing responses relative to vignettes portraying untreated mental illness. Responses to questions about perceived norms followed similar patterns. The primary limitations of this study are that the vignettes may have omitted ...

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Section: Discussionmentioning

confidence: 99%

Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda

et al. 2019

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“…Clinical supervision has been suggested to significantly decrease levels of burn out among staff working in community mental health services in the UK [ 9 , 10 ]. Given this, it is not surprising that Ugandan clinical psychologists who are working under exceptional pressures to meet the mental health needs of this country without any clinical supervisory structures in place [ 11 , 12 ], have reported feeling “burnt out” and “demoralised” [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…This was because previous research suggests “Western” therapies and methods of clinical psychology are useful in the Ugandan context (e.g. [ 37 ]) and clear gaps had been identified previously by Ugandan clinicians in the restorative and normative aspects of supervision [ 13 ]. It was expected that the useful and not so useful aspects of supervision may be different to those described by the Western clinical psychology students.…”

Section: Introductionmentioning

confidence: 99%

“…Ugandan health and education sectors are based on the British systems, following the colonial rule from 18951 to 962 [ 38 ]. The hierarchy and ethnic division which was imposed on Uganda within this time [ 39 ] may still be impacting on Ugandan society, for example it has been stated that a “Doctor is next to God” in Uganda [ 13 ]. Due to this, it possible that the Ugandan clinical psychology students may show a preference for a power hierarchy and a need to be “told” what to do.…”

Section: Introductionmentioning

confidence: 99%

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Clinical supervision for clinical psychology students in Uganda: an initial qualitative exploration

Hall

Kasujja

Oakes

2015

Int J Ment Health Syst

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BackgroundBurn out in clinical psychologists working in low income countries has been reported. Clinical supervisory structures do not yet exist in Uganda. A way to decrease levels of burn out and increase quality of care for people with mental illness is through clinical supervision. The aim of this study was to explore the initial experiences of supervision for clinical psychology students in Uganda to ascertain whether or not clinical supervision is culturally appropriate, and what aspects of supervision had been helpful and unhelpful.MethodsA qualitative design with thematic analysis was utilized. A focus group was held with 12 second year clinical psychology students to ask their experiences of receiving supervision.ResultsData analysis created five themes. Firstly, the negative emotions that resulted from the training processed were discussed, and how supervision helped and did not help the students to manage these. Secondly, the students voiced that supervision helped them to learn through observational experiences, co-therapist roles and parallel processes within the supervisory relationship. Thirdly, supervision had taught the clinical psychology students their role as a clinical psychology student, how to act within the Ugandan mental health system and skills to conduct therapy. Fourthly, suggestions for the future of supervision were given, with the students requesting for it to start earlier in the training, for supervisors who can meet with the students on a regular basis to be selected and for the training the students receive at university to match the skills required on their placements, with a request for more practical techniques rather than theory. The final theme related to left over miscellaneous data, such as the students agreeing with each other.ConclusionsThe students stated that supervision was helpful overall, implying that clinical supervision is culturally appropriate for clinical psychology students in Uganda. Suggestions for future supervision were given. In order to decrease high levels of staff burn out in the mental health systems in Uganda, supervisory structures with an emphasis on self care need to be established.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-015-0016-8) contains supplementary material, which is available to authorized users.

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“…A HCP tried to respond but his responses were often met with lethargy or a lack of resources to sustain projects: The overwhelming workload of HCP in Africa is well documented as is the resulting demoralisation of HCP [39].…”

Section: Lack Of Environmental Response and Supportmentioning

confidence: 99%

Health Care Professionals and Family Perspectives of Youth’s Trauma: Suggestions for Coaching and Self-Leadership

Jooste¹,

Maritz²

2015

TOFAMSJ

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Abstract:Family forms the first and most important social institution in every society. Although traumatised families may be the root of much personal and social turmoil, a healthy community and family is the most vital way to deal with social change and challenges. In the light of increasing violence and trauma in South Africa, youths adverse exposures to violence and trauma have been identified as a distressing health care problem globally and for our communities and families at large. This study sought to explore and describe community and family perspectives of youth's trauma in order to propose a holistic support approach. A qualitative approach was followed and participants (health care professionals and parents) were purposefully selected. Data were gathered through interviews, a focus group and field notes. Data were analysed thematically. Health care professionals and parents shared similar experiences and concerns relating to their perceptions of youths' experiences of trauma. Parents however had a more negative regard of the youth and their capabilities to deal with trauma. The trauma experience was seldom contained to the individual but had a traumatising ripple effect on the parents, and community. This often left the entire system feeling helpless and depleted of resources to cope.

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Mental health practitioners' reflections on psychological work in Uganda: exploring perspectives from different professions

Cited by 12 publications

References 10 publications

Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda

Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda

Clinical supervision for clinical psychology students in Uganda: an initial qualitative exploration

Health Care Professionals and Family Perspectives of Youth’s Trauma: Suggestions for Coaching and Self-Leadership

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