Abstract
BackgroundIn sub-Saharan Africa the treatment gap for mental disorders is high. In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHU) to every district. This study aims to retrospectively evaluate the uptake of these services by examining the pathways to care, diagnosis, management, and treatment gap, to provide insight into the functioning of these units and the potential burden of mental health disorders in Sierra Leone.MethodsWe evaluated the roll out of MHU using summary data from all units between 1 st January 2015 and 1 st January 2017, to establish the burden of diagnoses among service users, pathways to care, treatments provided, and treatment gaps. Negative binomial regressions examine bivariate relationships between diagnoses, treatments, and medication inaccessibility with demographics (age and sex), location (Freetown vs the rest and Ebola endemic regions vs the rest) and year.ResultsWe collected data from 15 MHU covering 13 districts in 24 months. There were 2401 referrals. The largest age category was 25–34 (23.4%). The prominent diagnoses were epilepsy (43.5%, associated with children) and psychosis (17.5%, associated with males). Reported depression (8.6%) and suicide attempts (33 patients) were low. Ebola endemic regions reported higher rates of grief, trauma, and medically unexplained symptoms. In 24.7% of cases where medication was required, it was not accessible.ConclusionsNurse-led MHU can have a modest effect on the treatment gap in resource constrained environments such as Sierra Leone, particularly in epilepsy and psychosis.
Highlights
In sub-Saharan Africa the treatment gap for mental disorders is high
The median proportion of available data per category of the data sheet was 70.9% (IQR 64.4–86.3%), with more data missing from certain categories and certain mental health units (MHU) (Kenema, Koidu, Magburaka and Moyamba), as shown in Appendix 2
Epilepsy/seizures were most frequently diagnosed (43.5%, 426 of 979), followed by psychosis (17.5%, 171) and ‘other psychological complaints’ (14.5%, 142), which is a diagnosis of exclusion if no other mental health disorder is present, encompassing stress, grief and trauma
Summary
In sub-Saharan Africa the treatment gap for mental disorders is high. This study aims to retrospectively evaluate the uptake of these services by examining the pathways to care, diagnosis, management, and treatment gap, to provide insight into the functioning of these units and the potential burden of mental health disorders in Sierra Leone. Mental health and substance use disorders constitute a high burden of disease, accounting for 23% of disabilityassociated burden (years lived with a disability, YLD) globally and 19% in sub-Saharan Africa [1]. Evidence around task-sharing in mental health mostly focuses on primary care [7]. Models of task-sharing with trained nurses have been implemented, there is little evidence about the effectiveness of these programs outside of primary care in Africa [8,9,10]
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