Mental illness in Bwindi, Uganda: Understanding stakeholder perceptions of benefits and barriers to developing a community-based mental health programme.

Kristen L Sessions,Edwin Agaba,Deenah Farrell,Arya Shah,Yusufu Kuule,Lydia Wheeler,Stephen P Merry

doi:10.4102/phcfm.v9i1.1462

Abstract

BackgroundMental illness has been increasingly recognised as a source of morbidity in low- and middle-income countries and significant treatment gaps exist worldwide. Studies have demonstrated the effectiveness of task sharing through community-based treatment models for addressing international mental health issues.AimThis paper aims to evaluate the perceptions of a wide range of mental health stakeholders in a Ugandan community regarding the benefits and barriers to developing a community-based mental health programme.SettingBwindi Community Hospital (BCH) in south-west Uganda provides services through a team of community health workers to people in the Kanungu District.MethodsThematic analysis of 13 semi-structured interviews and 6 focus group discussions involving 54 community members and 13 mental health stakeholders within the BCH catchment area.ResultsStakeholders perceived benefits to a community-based compared to a hospital-based programme, including improved patient care, lower costs to patients and improved community understanding of mental illness. They also cited barriers including cost, insufficient workforce and a lack of community readiness.ConclusionsStakeholders express interest in developing community-based mental health programmes, as they feel that it will address mental health needs in the community and improve community awareness of mental illness. However, they also report that cost is a significant barrier to programme development that will have to be addressed prior to being able to successfully establish such programming. Additionally, many community members expressed unique sociocultural beliefs regarding the nature of mental illness and those suffering from a psychiatric disease.

Highlights

Studies on the effects of deinstitutionalisation of mental health services have revealed both success and failures with regard to the treatment of mental illness.[1]
Though mental illness is being increasingly recognised as a source of morbidity in low- and middle-income countries, significant treatment gaps continue to exist throughout the world, limiting access to mental health services for most persons.[5]
We explore perceptions of a wide range of mental health stakeholders in a Ugandan community regarding the benefits and barriers to developing a community-based mental health programme

Summary

Introduction

Studies on the effects of deinstitutionalisation of mental health services have revealed both success and failures with regard to the treatment of mental illness.[1] task sharing models, involving the provision of resources to expand the health workforce through widespread training and dissemination of non-physician healthcare workers, are being increasingly studied for their potential to address the global shortage of mental health services through the development of community-based mental health programmes.[2,3,4] Though mental illness is being increasingly recognised as a source of morbidity in low- and middle-income countries, significant treatment gaps continue to exist throughout the world, limiting access to mental health services for most persons.[5]. Studies have demonstrated the effectiveness of task sharing through community-based treatment models for addressing international mental health issues

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