Community Mental Health Programs Research Articles

Psychometric properties of a questionnaire on medical students’ satisfaction with a community health program

Changes in the learning modes during the recent COVID-19 pandemic has provided a need to construct a feedback questionnaire to measure medical students’ satisfaction with community-based health programs. A total of 551 forms which has a 5-point Likert scale were submitted by the medical students upon concluding the public health program in 2018-2021 (which includes face-to-face and virtual learning). Reliability coefficients were estimated for each factor (domain) with values >0.70. Exploratory factor analysis (EFA) was used to assess the validity of the instrument, using principal components analysis with varimax rotation. EFA identified two factors; the first included 6 items (67.031%) of the total variance, the second explained 4 items (10.114%) and together explained 77.15%. root mean squared error of approximation (RMSEA): 0.074; normed fit index (NFI): 0.975; comparative fit index (CFI): 0.981; incremental fit index (IFI): 0.981; goodness of fit index (GFI): 0.956; Tucker Lewis index (TLI): 0.972. The overall students’ satisfaction had a Cronbach’s alpha test of 0.945 with a 95% confidence interval (0.938-0.952), and a reliability using Guttman Split-Half for overall was 0.894. Students’ satisfaction questionnaire with the public health program has a good reliability and validity in contrasting educational situations and it is worthwhile to include as part of the quality improvement.

Implementing an evidence-based behavioral weight-loss program in community mental health centers: A randomized pilot study.

Obesity is a leading cause of preventable death among individuals with serious mental illness (SMI). A prior randomized controlled trial demonstrated the efficacy of a lifestyle style intervention tailored to this population; however, such interventions need to be adapted and tested for real-world settings. This study evaluated implementation interventions to support community mental health program staff to deliver an evidence-based lifestyle intervention to clients with obesity and SMI. In this cluster-randomized pilot trial, the standard arm combined multimodal training with organizational strategy meetings and the enhanced arm included all standard strategies plus performance coaching. Staff-coaches delivered a 6-month group-based lifestyle intervention to clients with SMI. Primary outcomes were changes in staff knowledge, self-efficacy, and fidelity scores for lifestyle intervention delivery. Linear mixed-effects modeling was used to analyze outcomes, addressing within-site clustering and within-participant longitudinal correlation of outcomes. Three sites were in the standard arm (7 staff-coaches); 5 sites in the enhanced arm (11 staff-coaches). All sites delivered all 26 modules of the lifestyle intervention. Staff-coaches highly rated the training strategy's acceptability, feasibility and appropriateness. Overall, mean knowledge score significantly increased pre-post by 5.5 (95% CI: 3.9, 7.1) and self-efficacy was unchanged; neither significantly differed between arms. Fidelity ratings remained stable over time and did not differ between arms. Clients with SMI achieved a mean 6-month weight loss of 3.8 kg (95% CI: 1.6, 6.1). Mental health staff delivering a lifestyle intervention was feasible using multicomponent implementation interventions, and preliminary results show weight reduction among clients with SMI. The addition of performance coaching did not significantly change outcomes. Future studies are needed to definitively determine the effect on client health outcomes.

Community Health Programs and Partnerships: Perspectives from Public Library Directors

This study, centered around a survey of library directors (N = 83), examines community health programming (CHP) in Michigan’s public libraries within the broader context of national CHP initiatives. Reponses indicate that while physical activity classes and food skills programs are popular, there are still challenges to overcome. These findings led us to recommendations for cultivating partnerships that can help CHP grow and flourish.

Adherence to Antipsychotics among Patients with Schizophrenia at Selected Tertiary Level Hospitals

Background: Schizophrenia is a severe mental disorder where nonadherence is present in patients so that relapse, rehospitalization and treatment resistant can occur. Objectives: To identify the level of adherence to antipsychotics among patients with schizophrenia and to find its association with socio-demographic variables. Materials and method: A descriptive, cross-sectional study design was used for the study. 422 samples were collected using the purposive sampling technique Data was collected by the face-to-face interview technique during March, April, and May 2023. Questionnaire related to Socio-demographic information, standard valid tool Drug Attitude Inventory (DAI-10) was used as instrument. Data were analyzed using descriptive and inferential statistics with SPSS version 20. Results: The mean age of the respondents was 41.02, ±12.77. More than half52 (12.3%) of respondents were taking antipsychotics for more than 15 years. Majority of respondents 342 (81.0%) were taking atypical types of antipsychotics. Only 220 (52.1%) of respondents has moderate level of adherence towards antipsychotic medicine. Significant association was found between duration of illness and adherence level where p=0.006. There is mean difference found p=<0.001 from nonadherent group to moderate adherent and adherent group and from moderate adherent-to-adherent group. Conclusion: Nonadherence was found important factor low Quality of life among schizophrenia patient. Implementation of community mental health program is necessary to reduce treatment gap and decrease nonadherence. It is essential to improve adherence on antipsychotic for better quality of life among schizophrenia patient.

Performance of Community Health and Nutrition Volunteers and Associated Factors in Hajjah, Yemen

Background: since the Community Health and Nutrition Volunteers (CHNVs) program established, the performance of CHNVs has never been evaluated. Aims: to evaluate the performance of the CHNVs, and its associated factors. Methods: a cross-sectional study design was conducted in Bani Qais and Al-Maghrabah districts, Hajjah governorate between January and April 2023. Odds ratios with 95% confidence intervals (CI) were calculated. A p-value < 0.05 was considered statistically significant. Results: A total of 65 CHNVs participated in this study. Almost 53.8% of CHNVs had-high performance, 29.2% had moderate performance, and 16.9% had low performance level. The multivariate regression analysis of factors associated with the performance of CHNVs revealed that the percentage of CHNVs who were involved in an occupation was high-performance compared to those not involved in any occupation (68.8% vs 39.4%). This association was statistically significant [adjusted odds ratio (aOR) = 10.8, 95% CI: 1.1-105.9, p value = 0.041]. Moreover, the percentage of CHNVs who serve 22 or less children under 24 months old was high-performance compared to those serving more than 22 children under 24 months old (69.7% vs 37.5%). This association was statistically significant (aOR = 7.9, 95% CI: 1.2 - 51.5, p value = 0.031). Conclusions: the performance of CHNVs is inadequate. The main job and number of children under 24 months served were significantly affected the performance of CHNVs.

Usability and Acceptance as Facilitators of Behavioral Intention to Use a Mixed Reality Exercise Program in Older Adults: A Structural Equation Model

BackgroundStaying active has been one of the mainstays in promoting health in older adults. Despite the potential of innovative health technologies for fitness, there is limited understanding of the factors influencing older adults’ behavioral intention to engage in mixed reality physical exercise. PurposeTo develop a theoretical model of technology usability and acceptance influencing behavioral intention to use a mixed reality physical exercise program among older adults. DesignA cross-sectional study was conducted to develop a virtual exercise coach in a mixed-reality environment. Older adults (n = 64) were purposively selected from a community senior center in the Philippines and participated in the exercise program. Their responses were analyzed using a partial least square approach to structural equation modeling. ResultsThe generated measurement model demonstrated valid and reliable estimates. Its structural model (R2 = 0.64) had a good fit (GoF = 0.56) with consistent quality indices. It also indicated that performance expectancy, facilitating conditions, and information quality are significant (p < 0.05) factors explaining behavioral intention to use the virtual coach system among older adults. ConclusionThe belief in technology usefulness, trust, data quality, and the value of shared responsibility between the technology promoters and users significantly facilitates behavioral intention to use mixed reality virtual coach systems. The study results are valuable in developing technologies and improving older adult participation in technology-driven community health programs.

Unani Fundamentals portraying Public Health and Healthy Nation

The establishment and upkeep of national health depends heavily on public health. The endeavor entails employing diverse tactics and measures to safeguard, enhance, and elevate the well-being of societies. Unani medicine, an ancient system of healing that originated in Greece and was later developed and enriched by Persian and Arabic physicians, has its own set of principles that can contribute to public health and the creation of a healthy nation.Unani fundamentals approaches health holistically, taking into account physical, mental, social and spiritual factors.In addition to providing customized care based on a patient's constitution (temperament or Mizaj), Unani system of medicine has several other benefits for the general public's health for example prevention and maintenance of one’s health through ‘Asbab Sitta Daruriyya waGhair Daruriyya’ that includes dietary recommendations, lifestyle modifications, sleep patterns and performing practices like cleanliness and moderation, doing exercise etc. Additionally, integrating Unani medicine into community health programs like health camps, awareness sessions and distribution of herbal formulations for common ailments can provide a holistic approach to healthcare. In summary, Unani medicine's emphasis on holistic health, preventive care, individualized treatment, natural remedies, lifestyle modifications, community health, and integration with modern medicine aligns with the goals of public health. The objective of this study is to shed light on the foundations of Unani medicine, which is crucial for preserving health at all levels and enhancing it when combined with contemporary medical procedures to improve health both nationally and among individuals.

Challenges and sustainability of Indian mental health: evaluating volunteer-based community mental health clinics with a complex adaptive system framework

PurposeThis study aims to evaluate how a community psychiatry model, referred to as the Mental Health Action Trust (MHAT) in India, provides decentralized care and comprehensive services to people with severe mental illness living in poverty. Using the complex adaptive system (CAS) framework, the authors aim to understand the factors that contribute to the diverse outcomes of the MHAT community mental health programme as observed in four different locations.Design/methodology/approachFour MHAT clinics were purposively chosen from two districts in Kerala. A comparative case study methodology was used to document each clinic’s MHAT services and activities, as found during field visits and interviews with staff members and volunteers.FindingsThe study shows that all four clinics met the basic aim of providing free, quality mental health care to the poorest populations, although not all aspects of the comprehensive model could be equally provided. Alignment with the MHAT vision, appropriate leadership, the relationship with partners and their level of community engagement determined the varied success between clinics.Originality/valueThe current study evaluation stresses that community ownership is crucial. Careful attention must be paid to the characteristics of selected partners, including their leadership styles and ability to garner resources.

Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar.

Despite widespread adoption of community health (CH) systems, there are evidence gaps to support global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. The nongovernmental health organization Pivot partnered with the Ministry of Public Health (MoPH) to pilot a new enhanced community health (ECH) model in rural Madagascar, where one CHW provided care at a stationary CH site while additional CHWs provided care via proactive household visits. The program included professionalization of the CHW workforce (i.e., targeted recruitment, extended training, financial compensation) and twice monthly supervision of CHWs. For the first eighteen months of implementation (October 2019-March 2021), we compared utilization and proxy measures of quality of care in the intervention commune (local administrative unit) and five comparison communes with strengthened community health programs under a different model. This allowed for a quasi-experimental study design of the impact of ECH on health outcomes using routinely collected programmatic data. Despite the substantial support provided to other CHWs, the results show statistically significant improvements in nearly every indicator. Sick child visits increased by more than 269.0% in the intervention following ECH implementation. Average per capita monthly under-five visits were 0.25 in the intervention commune and 0.19 in the comparison communes (p<0.01). In the intervention commune, 40.3% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 85.4% of observed visits in the intervention commune (vs 57.7% in the comparison communes, p-value<0.01). This evaluation demonstrates that ECH can improve care access and the quality of service delivery in a rural health district. Further research is needed to assess the generalizability of results and the feasibility of national scale-up as the MoPH continues to define the national community health program.

Prevalence of complete edentulism among US adults 65 years and older: A Behavioral Risk Factor Surveillance System study from 2012 through 2020

BackgroundThe rapid growth of the older adult population in the United States and their increased risk of edentulism make it essential to analyze trends and factors associated with edentulism. MethodsData were obtained from the Behavioral Risk Factor Surveillance System from 2012 through 2020. US- and state-level trend lines were reported. Multiple logistic regression analyses were used to evaluate the association between self-reported complete edentulism and demographic characteristics, chronic diseases, smoking status, and health insurance status. Multiple imputations were used to address the missing data. ResultsA total of 771,513 (weighted n = 50,410,576) participants were included in the study. There was a significant (P = .021) downward trend in the prevalence of edentulism from 2012 (16.36%) through 2020 (13.54%). Having less than a high school education, being a smoker, being non-Hispanic Black, having an annual household income less than $75,000, and having chronic conditions, including diabetes, myocardial infarction, arthritis, depression, and stroke, were significantly associated with complete edentulism. ConclusionsDespite a decrease in prevalence of edentulism, disparities based on race, income, and education still exist. Edentulism is associated with chronic diseases in older adults. Practical ImplicationsPublic health initiatives should be aimed at reducing the impact of edentulism and improving overall quality of life among older adults. Community health programs allocating resources to improve access to affordable care, reducing precursors to edentulism, expanding dental coverage, and promoting oral and general health awareness are vital components of these efforts.

Reducing the equity gap in under-5 mortality through an innovative community health program in Ethiopia: an implementation research study

BackgroundThe Ethiopian government implemented a national community health program, the Health Extension Program (HEP), to provide community-based health services to address persisting access-related barriers to care using health extension workers (HEWs). We used implementation research to understand how Ethiopia leveraged the HEP to widely implement evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) and address health inequities.MethodsThis study was part of a six-country case study series using implementation research to understand how countries implemented EBIs between 2000–2015. Our mixed-methods research was informed by a hybrid implementation science framework using desk review of published and gray literature, analysis of existing data sources, and 11 key informant interviews. We used implementation of pneumococcal conjugate vaccine (PCV-10) and integrated community case management (iCCM) to illustrate Ethiopia’s ability to rapidly integrate interventions into existing systems at a national level through leveraging the HEP and other implementation strategies and contextual factors which influenced implementation outcomes.ResultsEthiopia implemented numerous EBIs known to address leading causes of U5M, leveraging the HEP as a platform for delivery to successfully introduce and scale new EBIs nationally. By 2014/15, estimated coverage of three doses of PCV-10 was at 76%, with high acceptability (nearly 100%) of vaccines in the community. Between 2000 and 2015, we found evidence of improved care-seeking; coverage of oral rehydration solution for treatment of diarrhea, a service included in iCCM, doubled over this period. HEWs made health services more accessible to rural and pastoralist communities, which account for over 80% of the population, with previously low access, a contextual factor that had been a barrier to high coverage of interventions.ConclusionsLeveraging the HEP as a platform for service delivery allowed Ethiopia to successfully introduce and scale existing and new EBIs nationally, improving feasibility and reach of introduction and scale-up of interventions. Additional efforts are required to reduce the equity gap in coverage of EBIs including PCV-10 and iCCM among pastoralist and rural communities. As other countries continue to work towards reducing U5M, Ethiopia’s experience provides important lessons in effectively delivering key EBIs in the presence of challenging contextual factors.

Factors Associated with Beneficiary Outcomes from Community Health Programs in Predominantly Low-Income African American Communities in Mississippi USA.

Community health programs (CHPs) can improve the conditions of disadvantaged populations through direct health and support services. We examine factors associated with two CHP beneficiary outcomes including program needs being met and satisfaction in the low-income and predominantly African American cities of Belzoni and Jackson in Mississippi, USA. A retrospective and cross-sectional design is implemented using chi squared tests and regression analysis of 108 survey responses from a convenience sample. Chi-squared test results associate program meeting needs with gender, participation, efforts towards financial success, and financial condition. Satisfaction is also associated with age, marital status, gender, years at address, degree of participation, ethnicity, efforts at financial success, and financial condition. Equally, logistic regression analysis associates satisfaction with marital status, gender, years at address, age group, ethnicity, education, and efforts at financial success. The negative relationship between participation in program activities and satisfaction, and the large size of participants (42-57%) who areless likely to report satisfaction with services, calls for an investigation of the causes of low levels of satisfaction. Immediate and long-term improvements needed to strengthen the fit between CHP services and beneficiary needs in Belzoni and Jackson are recommended.

Positive Coping and Community Resilience in Disaster Management for Flooding in Malaysia

Background: Flood disasters increase the risk of both direct health impacts like trauma, injuries, and infectious diseases, as well as indirect impacts such as displacement-related and mental health problems. Disasters, though devastating, can have their adverse effects mitigated. A pivotal aspect in disaster management is community resilience, which is instrumental for sustainable recovery and growth. Individuals' readiness to take preparedness measures that increase community resilience might be influenced by their coping mechanisms. This study assessed the association between positive coping and community resilience among affected communities in Shah Alam, Malaysia. Methods: We conducted a cross-sectional study and recruited participants by using purposive sampling. The participants were required to self-report their sociodemographic profile, coping, and community resilience. Coping was assessed using the Brief-Coping Orientation to Problems Experienced scale, and community resilience was assessed using the Communities Advancing Resilience Toolkit survey. Multivariable logistic regression was performed. Results: The findings demonstrated that problem-focused coping was the strongest predictor for community resilience in all domains. Participants with low problem- and emotion-focused coping were associated with low community resilience. Conclusion: A strong sense of social responsibility fosters more resilient communities. It is imperative to craft holistic community health programs, embedding both social responsibility and resilience, to proactively mitigate and manage disaster risks. As such, the adoption of comprehensive community resilience frameworks should be prioritized within health and disaster management blueprints.

Development and Evaluation of a Community Health Program to Promote Physical Activity Among Vulnerable Community-Dwelling Older Adults: Protocol for a Prospective Cohort Study.

Vulnerable older adults have a high risk of morbidity and mortality. Regular physical activity (PA) can have a positive effect on the health and health-related behavior of this specific target group. However, evidence of the impact and feasibility of community-based PA promotion interventions for vulnerable older adults is still limited. The BeTaSen (Bewegungs-Tandems in den Lebenswelten Chemnitzer Seniorinnen und Senioren: ein Beitrag zur kommunalen Gesundheitsförderung) study aims to evaluate the (1) impact as well as the (2) feasibility, acceptance, and usefulness of a 12-month low-threshold PA intervention program for community-dwelling vulnerable older adults. For our population-based prospective observational cohort study, a total of 120 vulnerable older adults (aged 75 years or older) in the area of Chemnitz (Germany) will be recruited to participate in (1) weekly neighborhood-based low-threshold PA meetings with trained mentors (activity tandems) and (2) monthly exercise meetings led by trained exercise instructors. Within the intervention, participants will be encouraged to perform the PA independently. Participants will complete assessments, which will include questionnaires as well as objective measurements of their physical, cognitive, and psychosocial health at 3 different time points (baseline, 6 months after the start, and 6 months after the end of the intervention). Additionally, a process evaluation will be performed, including questionnaires and qualitative interviews, involving the participants, mentors, and municipal project partner representatives. The BeTaSen project process began in October 2021, with the start of data collection and intervention in August 2022 in the first neighborhoods of the city of Chemnitz. A total of 86 participants were recruited at the time of submission of the manuscript. Longitudinal results are expected by 2025. This study's results will provide insights on (1) the PA behavior of vulnerable older adults as well as the impact of PA interventions on health-related outcomes such as cognitive, physical, and psychosocial health, and (2) the feasible and useful components of community-based PA interventions. Thus, this pilot study contributes to future recommendations and provides a basis for further research, such as the development of feasible and sustainable target group-specific interventions in community settings. DERR1-10.2196/51462.

Factors of success, barriers, and the role of frontline workers in Indigenous maternal-child health programs: a scoping review

BackgroundDespite considerable investment in maternal-child programs in Canada, there has been little positive impact on the health of Indigenous mothers and their children. The reasons for this are unclear and there is a need to identify how such programs can be successfully implemented. Community input is essential for successful programs; however, it is unclear what the contributions of frontline workers have been in the health program process, i.e., program development, delivery, and evaluation. Based on these identified gaps, this scoping review aimed to: (1) identify factors of success and barriers to successful Indigenous maternal-child community health programs for mothers and their children aged 0–6 years; and (2) explore how frontline workers are included in the program process.MethodsThis scoping review was completed using the Arksey and O’Malley framework, informed by Levac et al. Four data bases (Medline, CINAHL, Embase, and Scopus), grey literature, and reference lists were searched for relevant materials from 1990–2019. Data was extracted from included articles and analysed using descriptive statistics, thematic analysis with the Braun and Clarke framework, and a Principal Component Analysis.ResultsForty-five peer-reviewed and grey articles were included in the review. Factors of program success included: relationship building; cultural inclusion; knowledge transmission styles; community collaboration; client-centred approaches; Indigenous staff; and operational considerations. Barriers included: impacts of colonization; power structure and governance; client and community barriers to program access; physical and geographical challenges; lack of staff; and operational deficits. Frontline workers were found to have a role in program delivery (n = 45) and development (n = 25). Few (n = 6) had a role in program evaluation.ConclusionAlthough a better understanding of the frontline worker role in maternal-child health programs was obtained from the review, in a large proportion of literature the authors could not determine if the role went beyond program delivery. In addition, no direct input from frontline workers and their perspectives on program success or barriers were identified, suggesting areas to explore in future research. This review's findings have been applied to inform a community-based participatory research project and may also help improve the development, delivery, and evaluation of Indigenous maternal-child health programs.

Strategies and Challenges of a Safe Fireplace Program in Rural Kenya: A Qualitative Study.

There is a lack of information on effective burn prevention strategies. The objective of this study was to examine a safe fireplace program, as a method of burn prevention, in a resource-limited setting. We conducted a qualitative, phenomenological study at a community health and development program for a rural population in Kenya. Semi-structured, in-depth interviews were conducted with a purposive sample of community health workers involved with the safe fireplace program. Data were reviewed iteratively and coded independently by two researchers using NVivo 12. The study included five participants. Reflections from participants fell into three main domains: (1) effective methods of education, (2) strategies to incorporate stakeholders, and (3) implementation challenges. The results of this study emphasize the importance of community engagement in implementing a successful burn injury prevention program in a resource-limited setting. The participants involved in this study reported that rather than focusing on resources outside the community, effective methods of education and strategies for incorporating stakeholders depended on involving peers and community leaders. The challenges to the program were similarly specific to community concerns about resources and maintenance. These findings provide information to guide future community health programs in creating successful models for burn prevention strategies in resource-limited areas.

Intellectual and developmental disabilities in Ontario's criminal justice and forensic mental health systems: Using data to tell the story.

International studies show that adults with intellectual and developmental disabilities (IDD) are disproportionately represented in the criminal justice and forensic mental health systems; however, it is difficult to capture their involvement across systems in any one jurisdiction. The current study aimed to estimate the prevalence of IDD across different parts of the criminal justice and forensic mental health systems in Ontario and to describe the demographic and clinical profiles of these individuals relative to their counterparts without IDD. This project utilised administrative data to identify and describe the demographic and clinical characteristics of adults with IDD and criminal justice or forensic involvement across four sectors: federal correctional facilities, provincial correctional facilities, forensic inpatient mental health care and community mental health programmes. Questions were driven by and results were contextualised by a project advisory group and people with lived experience from the different sectors studied, resulting in a series of recommendations. Adults with IDD were over-represented in each of the four settings, ranging from 2.1% in federal corrections to 16.7% in forensic inpatient care. Between 20% (forensic inpatient) and 38.4% (provincial corrections) were under the age of 25 and between 34.5% (forensic inpatient) and 41.8% (provincial corrections) resided in the lowest income neighbourhoods. Medical complexity and rates of co-occurring mental health conditions were higher for people with IDD than those without IDD in federal and provincial corrections. Establishing a population-based understanding of people with IDD within these sectors is an essential first step towards understanding and addressing service and care needs. Building on the perspectives of people who work in and use these systems, this paper concludes with intervention recommendations before, during and after justice involvement.

‘Doctors advised to take medicines to remove these thoughts’: the violence and violations in sexual mental health care in community mental health programmes in Kerala

Abstract Community mental health programmes (CMHPs) have proliferated in both governmental and non-governmental sectors in recent times in India. Although CMHPs are mandated to work in close collaboration with the community, the operationalization of community is fraught with exclusionary tendencies, particularly concerning non-cis-heteronormative sexual subjects. Mental health professionals trained in the mainstream western biopsychiatric paradigm are largely silent on the lesbian, gay, bisexual, transgender, queer, intersex and asexual identity discourses as they institute pathological and reductive conceptualization about sexualities, psychosocial disabilities and resultant sufferings. Drawing on ethnographic fieldwork carried out at two non-governmental and a governmental CMHP in Kerala, south India, I illustrate the lack of a human rights–based approach to sex and sexual orientation and gender identity, due to which pressing concerns of sexual life are mis/overdiagnosed as mental ‘disorders’ to be treated within a biomedical framework. The lack of an intersectional approach fails the marginalized sexual subjects to exert their agency, develop critical consciousness and recognize sexuality as a political issue—all vital for transformative social change. The consequence is a dehumanized mental health care system that fails to ‘archive feelings’ that are pivotal in making invisibilized worlds observable to tell ‘unwelcome truths’ that induce psychic pain. Collaborative alliances among other marginalised sections like Queer, Dalit, tribal and Crip (disability) groups are vital in resisting intra-individual prescriptions by increasingly commercializing mental health practice in a country beset by a host of social problems including poverty, discrimination and rising inequalities. It is crucial to understand systems of power (imbalance) that operate as major (social) determinants of (sexual) mental health.

An exploration of the Indonesian lay mental health workers’ (cadres) experiences in performing their roles in community mental health services: a qualitative study

BackgroundVolunteers trained to support community mental health programs in Indonesia are known as ‘mental health cadres.’ These are lay people trained to provide basic support for people with mental illness in their local communities. The role of cadres in community mental health services is to provide health promotion activities and support for people with mental illness, such as home visits and family assistance. Their contribution can potentially address the challenges health services currently face in remote and resource-limited settings. However, little is currently known about implementing this form of the lay workforce and the experiences of mental health cadres in Indonesia in particular. This study aimed to explore the experience of cadres when performing their roles in community mental health services in Indonesia from the cadres’ perspective.MethodsThe study employed a descriptive qualitative design. Purposive sampling was employed to recruit cadres with at least one year of experience handling those diagnosed with schizophrenia across four geographical areas in Java and Sumatra, Indonesia. Data were collected utilising focus groups undertaken between July and November 2020. Due to COVID-19 restrictions, eight focus group sessions for mental health cadres were carried out virtually via Zoom and non-virtual, facilitated by local moderators. Data were analysed using thematic analysis.ResultsThe study involved 71 cadres in four regions: Aceh, Jakarta, West Java and East Java. The majority of participants were looking after their families with a minimum of high school-level qualifications. Four themes were interpreted from the data: (1) Motivation for volunteering, (2) The role of cadres in supporting mental health services, (3) Training and support needs in carrying out cadre roles, and (4) Barriers and facilitators to the implementation of cadre roles in local communities.ConclusionsCadres reported a motivation to help people improve their mental health and reduce the stigma associated with mental illness. Cadres also contributed to secondary and primary prevention of mental illness with some limitations. This study’s results are relevant to those wishing to understand and optimise the implementation of lay workforces in resource-limited settings.

Nurturing Resilience: The Tapestry of Filipino Values in Communal Strength

This article explores the resilience ingrained in the Filipino community, drawing from the Bahala Na mentality and Bayanihan values. It examines how these cultural elements give rise to a dynamic force within society that goes beyond individual capacities. The narrative centers on a community mental health program in Concepcion, Iloilo, initiated prior to the enactment of the Mental Health Law in the Philippines, tracing its impact over a decade. The article showcases the transformative influence of communal resilience, evident in the increased numbers of patients and the rehabilitation of individuals once considered hopeless. The article artfully weaves together both prose and poetry, capturing the enduring spirit of Concepcion. The conclusion acknowledges the persistent challenges in mental health awareness and suicide prevention. The integrated poetic journey serves to highlight the resilience ingrained in Concepcion, offering a unique perspective in a world often focused on individual achievements. The Filipino experience emerges as a guiding light, exemplifying the profound strength derived from communal bonds in facing life's adversities.