Mental Health Facilitator (MHF) Service Implementation in Schools in Malawi, Africa: A Strategy for Increasing Community Human Resources

Abstract

health research supports the notion that better care management is achieved when people receive education, training and support to carry out the role of informal caregivers (World Fellowship for Schizophrenia and Allied Disorders, 2006). Although the prevalence of mental disorders in is a significant health problem (Jenkins et al., 2010), treatment remains a low priority (Bird et al., 2011; Jacob et al., 2007), placed at the bottom of the public health care agenda. health patients of all ages and their families are too often invisible, voiceless and living at the margins of society, and they are rarely mobilized to advocate for themselves (Saraceno et al., 2007). In Africa, mental health receives less attention due to a plethora of problems with communicable diseases and malnutrition (Gureje & Alem, 2000). Moreover, the contribution of mental distress to morbidity, as well as mortality, largely goes underappreciated (Jenkins et al., 2010).Skeen, Lund, Kleintjes, Flisher, and the MHaPP Research Programme Consortium (2010) have reported: Mental health is a crucial public health and development issue in sub-Saharan Africa (p. 624). At least half of all African countries have no community-based mental health services, and almost as many have no integration of mental health into primary care or training facilities for primary care staff in the treatment of mental health (World Health Organization [WHO], 2005). In low-income countries like Malawi, essential psychotropic medications are not available, and resources for mental health training and care are largely lacking (Becker & Kleinman, 2013; WHO, 2004). Challenging the negative perception of mental disorders, reducing their prevalence and providing adequate care are essential policy goals for most of (Gureje & Alem, 2000), a continent where widespread stigma and discrimination, human rights abuses and poverty are the hallmarks of mental health care (Lund, 2010).In Africa, alternative explanations for mental distress, such as bewitchment, taboos and the belief that it runs in families, reduce the chances of access to mental health care (Bird et al., 2011; Wright, Common, Kauye, & Chiwandira, 2014). Moreover, attitudes about mental illness are strongly influenced by traditional beliefs (e.g., supernatural causes) and remedies. Public education that dispels notions that mental disorders are incurable and nonresponsive to typical care is needed (Gureje & Alem, 2000) as well as an effective strategy to decrease stigma (Bird et al., 2011). To accomplish these goals, governments, as well as nongovernmental organizations, need to bring community mental health services to scale (Hinkle, 2014; Patel, 2013; Patel et al., 2007). In 2006, Murthy reported that a global community mental health blueprint does not exist in order to achieve mental health access, and that national community workforce strategies need to be linked to each country's unique situation. Relatedly, Hinkle (2012a, 2014), among others, has advocated for a radical shift in the way mental disorders are managed, including increasing the numbers of trained community-based workers who can be effectively utilized via informal non-health care sectors, as well as formal health care systems (Bradshaw, Mairs, & Richards, 2006; Gulbenkian Global Health Platform, 2013; Petersen et al., 2009; Saraceno et al., 2007).About 70% of African countries spend less than 1% of their budgets on mental health, with most of these monies going toward large psychiatric hospitals rather than cost-effective, community-based care (WHO, 2005). health services are basically focused on emergency management (Petersen et al., 2009), with minimum long-term planning within the community. Resources for assisting people with mental stress, distress and disorders are insufficient, constrained, fragmented, inequitably distributed and ineffectively implemented (Becker & Kleinman, 2013; Chen et al. …