In order to scale up services in primary care, two sets of health workers are trained to detect, manage and treat priority mental health disorders and epilepsy: community psychiatric nurses (CPNs) and community health extension workers (CHEWs). CCMHP uses a drug revolving fund (DRF) to supply these workers with essential medicines, and both CHEWs and CPNs provide family education and support, though CPNs are trained in a broader range of psychosocial interventions.
A consultant psychiatrist from the Federal Medical Centre conducts quarterly site visits for the purposes of clinical supervision, while CCMHP staff make monthly visits to monitor implementation. Officers in charge (OICs) of each clinic and Heads of Department (HODs) for health in each local government area provide further oversight.
In addition to the clinical services offered in primary care, community-based activities raise awareness, improve detection, and support the rehabilitation and empowerment of service users, as described further below.
Services provided by Community Psychiatric Nurses (CPNs)
In each local government area, a nurse is identified to participate in an 18-month course on psychiatric nursing. After qualifying as a CPN he or she is assigned space and materials to establish an outpatient clinic within a special primary health care facility known as a Comprehensive Health Centre. The CPN also conducts mobile outreach, raises awareness in communities, and helps to organise self-help groups. A minimum of two days each week are reserved for clinic activities, and two reserved for outreach. CCMHP provides each CPN with a motorcycle to facilitate access to remote communities in what are often very large local government areas.
Services provided by Community Health Extension Workers (CHEWs)
In order to improve the accessibility of services and increase detection in primary care, non-specialist CHEWs from additional primary health care facilities volunteer to undergo a 5-day mental health Gap Action Programme (mhGAP) training. CHEWs already undergo basic training on community mental health as part of their degree qualifications, but mhGAP further equips them to identify priority mental and neurological disorders, refer severe cases, and manage non-severe cases on an outpatient basis, through a combination of pharmacological treatment and family education and support. Unlike CPNs, CHEWs do not provide outreach services, as they are intended to remain accessible within the clinic as much as possible.
- Self-help groups are organised for service users and caregivers to support each other, advocate for their rights, and participate in economic empowerment activities (including a group loan scheme).
- Advocates are trained to raise awareness, identify cases to refer to the appropriate provider, and follow-up on those receiving treatment in the community.
- Community-based rehabilitation facilities operated by the Methodist Church Nigeria and supported by CCMHP offer inpatient care for indigent cases and support their reintegration, reuniting service users with their families and offering long-term outpatient care and follow-up.