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FORMATIVE RESEARCH FOR THE MENTAL HEALTH BEYOND FACILITIES PROJECT IN ERUTE SOUTH HEALTH SUB-DISTRICT LIRA DISTRICT IN UGANDA

Rose KisaElialilia S. Okello

Florence Baingana

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INTRODUCTION “Mental health Beyond Facilities” (mhBef) project is a multi-site project

involving 3 post conflict countries of Uganda, Liberia and Nepal

The aim of the project is to implement evidence-based and sustainable “Comprehensive Community- based Mental Health Services” (CCMHS)

The formative research for the project was conducted to inform the design and implementation of evidence-based and sustainable CCMHS package in Uganda

CCMHS package components are:i. Health component +mobile healthii. Patient support groupsiii. Anti stigma activities

Target population: severe mental illness and epilepsy (SMIE)

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GENERAL OBJECTIVE

To gain an understanding of the; views, interests and needs of people in Erute South Health Sub District (HSD) to guide the definition, development and implementation of CCMHS interventions

SPECIFIC OBJECTIVES To establish the training and skills levels of HCWs

To identify available mental health services, including psychotropic medicines

To describe the current pathways to care for PWSMIE

To assess the current status of social support networks including PSGs, and the feasibility of developing PSGs for PWSMIE

To explore attitudes and practices towards PWSMIE

To assess acceptability, and feasibility of use of smart mobile phones in strengthening the skills of lower level health care workers in the diagnosis and treatment of PWSMIE 4

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METHODOLOGY 1

Study design: Cross sectional descriptive, qualitative methods

Study site: The study was conducted in Erute South HSD in Lira

Study population : Adults 18 – 60 years i. District: Policy makers and NGO administratorsii. Health facilities: HCWsiii. Community: VHTs, Local leaders, Religious and traditional

healers, teachers, PWSMIE and caregivers

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METHODOLOGY 2 Sampling: Purposive sampling

Selection of participants: The mhBeF field team worked closely with the project partners – TPO-Uganda in Lira, CDO Lira District, and ACDO for Erute HSD and the District Health Officer, Lira to identify the respondents

Sample size: 29 KIIs, 12 FGDs and 6 IDIs

Data collection procedures: translation and adaptation of instruments, training of RAs

Data collection methods: KII, FGDs and IDIs

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METHODOLOGY 3Instruments

Key informant interview guide Focus group discussion guide In depth interview guide

Data management & Analysis Data was transcribed, translated, and cleaned Merged with field notes to make final transcripts Data coding and analysis in Atlas.Ti computer software Content analysis

Ethical approval: The study was reviewed and approved by HDREC of MUSPH

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RESULTS 1 All PHCWs received some basic training in mental health but

MH component is limited or non-existent for non-MH specialists in the curriculum

“I think all (trainings) right from nurses (up to the doctors) have mental health component. Not into detail but just elementary. It is just to help you identify a mental illness case and at least make a referral. .. I don’t know if they have revised the curriculum but the one we were trained with would be having topics like epilepsy” (Health worker in a HC IV)

Mobile health was perceived feasible but un sustainable

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RESULTS 2 The health belief systems guided people’s health seeking

practices“So many of our people (with mental illness) visit the witchdoctors and yet the cases may have nothing to do with witchcraft… they are clearly mental disorders but you find people flocking to them. It is common here. Others visit churches and pastors pray for them and you see them falling down” (Journalist)

Psychotropic medicines were in some but not all facilities “Being a Health Center IV we can order for anything; but for health center IIIs they are given the essential ones only... They only have tablets and not injectables; but for us we have the options of ordering what we want... even if they are not on the essential list” (HCW in hospital)

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RESULTS 3 PSGs model was perceived as feasible and acceptable

High level of stigma towards PWSMIE and their family members is evident at workplace and community levels

“Yes, for me I don’t have a voice in the staff room; other teachers always refer to me as a mad man whose words are useless” (IDI PWSMIE)

Lack of community mental health (MH) services“For persons with severe mental illness they (groups) are not there.

People say there is no need of providing support for mad people. That is the mentality here in the communities” (FGD Caregivers)

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CONCLUSION

Training about MH for both community and PHCWs establishment of community MH blended with PSGs to reduce stigma while fostering adherence and economic empowerment for PWMIE are needed

Significance: Findings are in line with the design of the CCMHS interventions

Acknowledgement: Grand Challenges Canada (GCC), mhBeF fraternity, Lira DLG and participants

THANKS FOR LISTENING 12