Innovation summary

In many major cities within Nigeria, homeless people with mental illness suffer the most severe forms of poverty, often being without shelter, food, care and clothing. Moreover, they are also exposed to various forms of humans rights abuses such as physical and sexual abuse, restraint and extorted by fake healers who use them for begging on the streets1.

To address this need, Amaudo Itumbauzo implemented a rehabilitation programme3 solely for this population with the primary goals to:

  • Reduce destitution among people with mental illness through rehabilitation and reintegration with families
  • Provide affordable and accessible mental health care for people with mental disorders in economically disadvantaged communities
  • Reduce the human right abuses within the setting

To achieve this, the programme used the concept of community support to develop a rehabilitation centre where people eat, work, play and worship together. Having a dedicated space for community support is an important component of this rehabilitation programme as the homeless people recruited had been abandoned by their families and society. The centre uses a holistic approach to rehabilitation including integrating medical, social, occupational and psychological services.

The programme has a structured process for reintegration of clients with their families after recovery.  All clients receive vocational training prior to discharge, and are supported to pursue their chosen vocation in their home setting. When ready to go home (typically between 3 months and 6 months), they are taken for a brief visit to find their community and family. There is often need to rebuild these relationships. Following this visit, they then go on further short visits at home, addressing any reintegration issues, before final discharge, when the family is invited to the Centre for training on basic mental health issues and human rights which culminates in a discharge service.  

Impact summary

  • 930 homeless people with mental illness rehabilitated and reunited with families
  • 3000 people received rehabilitation from community mental health clinics integrated into state primary health care centres, supported by the programmeme in four states of South East Nigeria thereby closing the treatment gap
  • Affordable community care - clients pay approximate $3 monthly for prescribed drugs and consultation fees are not charged because the programme relies on psychiatric nurses employed by the government for implementation
  • Accessibility - The community mental health clinic is accessible to clients locally, thereby reducing the burden and cost of transportation to big psychiatric hospitals located in the big cities

"Without Amaudo and the psychiatric nurse that handled my case maybe I would be dead by now"

- A member of the Amaudo Rehabilitation Programme

Innovation details

In Nigeria mental health care is very neglected. As in other sub-Saharan countries, less than 1% percent of total health budget is allocated to mental health2. Government mental health care is provided through the 8 special mental health hospitals located in big cities in the six geopolitical zones of the country, and a similar number of university teaching hospitals. This is grossly inadequate compared to national population of over 180 million people with over 20 million mentally ill people. There is also strong stigma and human rights abuse of mentally ill people in Nigeria, including their right to health1. This lack of mental health resources somewhat explains why there are so many people with mental illness in Nigeria who roam the streets without shelter, food, mental health care and always suffer other forms of human right abuse.

Rising to this urgent need, the rehabilitation program was set up to provide mental health care to homeless mentally ill people without any familial or social support within the African community setting. This has brought hope to some families with limited options for seeking mental health treatment would often abandon their relative or take them to prayer house where there is a risk of suffering human rights abuses and limited chances of recovery.

The programme tries to fill the gap in Nigerian mental health care through a community mental health service which provides local services to people with mental illness through 73 community mental health clinics located within four states of South East Nigeria. The clinics continue to provide services to those rehabilitated at the programme centre who have been discharged and reintegrated with their families. Several awareness projects are also carried out to educate community members on mental health issues and protecting the human rights of people with mental illness. The programme recently began a Free Mobile Community Mental Health Care and Awareness Project targeting economically disadvantaged rural dwellers that have mental health disorders but are unable to access mental health care. This helps to identify people who have mental health disorders in remote rural communities for mental health treatment as well as reduce the level of mental health stigma in the community.

Key drivers

Strong relationships with local partners

  • Successful cooperation with local community for the establishment of a residential rehabilitation centre where community and clients receiving rehabilitation can interact without being stigmatized or denied their human rights. Community members do not fill threatened by the presence of people with mental illness in these settings.
  • Strong partnership with the government for secondment of psychiatric nurses who provide services in 73 community mental health clinics in four states of South East Nigeria
  • Effective collaboration with international NGOs like Amaudo UK for funding, support in training and staff development

Utilization of local support mechanisms

  • People with mental disorders are treated locally with the support of community members
  • Communities are engaged in mental health care aiding in successful referrals to community mental health clinics and leading to a gradual reduction in human rights abuses

Effective leadership structures

  • The programme is supervised by a Board acting for the Methodist Church of Nigeria
  • Monthly management meetings are held to review activities and provide support for oversight of coordinators
  • Strong system of accountability and supervision has helped to ensure that services are delivered and the programme is sustainable

Challenges

Prevailing stigma and prejudice

  • Stigmatization and discrimination of people with mental health under rehabilitation at Amaudo by family and society. These result in poor care at home and high risk of relapse.
  • Poor knowledge of mental health issues in the community

Local and political instability

  • Difficulty engaging with governance for advocacy purposes and persuading policy makers to design or implement effective policies for mental health care
  • Insecurity in Nigeria like the increased rates of kidnapping in South East and Boko Haram and the herdsmen/farmers clashes in the North made it difficult for foreign partners to visit Nigeria or travel freely
  • Change in government policy that affect social services like the ban of the use of motorcycles in cities in Abia State had made it challenging for service users to visit the community mental health clinics
  • Poor provision of social infrastructure like roads and electricity by the government leads to logistical difficulties for the programme, adding burden and costs to travel

Abuse of human rights

  • Lack of human right based mental health law in Nigeria. This increases the chances of human rights abuses against people with mental illness and makes advocacy difficult

Continuation

The community mental health programme started in Abia State in South East Nigeria in 1994 but it has been scaled up to cover 3 other states namely – Imo, Ebonyi and Anambra states in the same region. A Mental Health Awareness Programme was conducted through the programme in 2009 to 2013 to address issues of stigma and human rights abuse and to increase referral to community mental health programs.

The programme also provides mental health care experience for student nurses from various Universities and schools.

Partners

  • Methodist Church Nigeria Amaudo Itumbauzo
  • Amaudo UK

Funders

  • Methodist Church Nigeria
  • Amaudo UK
  • Abia State Government, Nigeria

Evaluation methods

An external evaluator from Amaudo UK visits the programme yearly to assess the project implementation and impact.

Currently the programme is being evaluated by an external evaluator from City College New York, U.S., for impact evaluation, building collaboration, understanding programme strengths and weakness and for prospects of growth and improvement.

Cost of implementation

The programme has an annual budget of about 40,000,000 Nigeria Naira (equivalent to around GBP 80,000) while monthly costs for rehabilitation average approximately 12,000 Nigeria Naira per person (GBP 25).

Over the past 20 years, Amaudo has carried out various projects like Awareness Raising, training for psychiatric nurses and other government personnel which have totalled over GBP 1 million.

Impact details

  • 930 people who were destitute and mentally ill have been rehabilitated and reintegrated with their families and society by the programme
  • Over 3000 mentally ill clients visit the community mental health clinics monthly for treatment thereby bridging the gap created by government psychiatric hospitals which are located in big cities in the six geopolitical zones of Nigeria
  • 9 Service User Groups or Self Help Groups (SHG) have been formed comprising of previously mentally ill persons who have received treatment from the programme, are now in recovery and have reconnected with their care givers. These groups meet monthly for mutual support and advocacy.
  • There is a gradual change in attitudes towards the mentally ill in society because recovery after treatment and reintegration with families is now highlighted and this reduces stigma against the clients and family.
  • There is a gradual shift in the increase of referrals to clinics in comparison to visiting herbalists or native doctor as the first choice among community members.
  • Communities are more engaged in mental health care
  • Over 3000 student nurses have participated in community mental health care training and experience from Amaudo Itumbauzo.

References

  1. Eaton J, Gureje O et al. (2018) A structured approach to integrating mental health services into primary care: Development of the Mental Health Scale Up Nigeria intervention (mhSUN). International Journal of Mental Health Systems, 12:1 [Link]
  2. Eaton J, Des Roches B, Nwaubani K and Winter L. (2015) Mental health care for vulnerable people with complex needs in low income countries; Two services in West Africa. Psychiatric Services, 66:1-3 [Link]
  3. Adeyinka M. Akinsulure-Smith, Enyi Anosike & Kenneth Nwaubani. (2017) Amaudo Itumbauzo: A Model for Community Based Psychosocial Services in Nigeria. Journal of Psychosocial rehabilitation and mental health, 4(1): 99-102. [Link]

Reports

Comments

Submitted by Justin Wheeler on Thursday, 10th September 2020
I am interested in helping out with this cause.
How useful did you find this content?: 
0
Your rating: None
0
No votes yet
Log in or become a member to contribute to the discussion.

Submit your innovation

Create your own page to tell the MHIN community about your innovation.

Country

Nigeria

Gallery

Similar content

node teaser-image

Self-Help Groups for Mental Health

A network of self-help groups running in the Upper East Region of northern Ghana
Region: 
Africa
2378 reads
node teaser-image

mhGAP Implementation in Edawu, Nigeria

mhGAP training for lay health workers in Edawu to assess and manage mental health conditions and promote mental health awareness in the community.
Region: 
Africa
Population: 
Children and adolescents
Adults
Older adults
Families and carers
Disorder: 
All disorders
896 reads
node teaser-image

Comprehensive Community Mental Health Programme

Outpatient services available though primary care and community facilities in local government areas throughout Benue State
Region: 
Africa
Disorder: 
All disorders
6288 reads
node teaser-image

Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE)

Community based rehabilitation (CBR), which involves working with individuals, families, and communities.
Region: 
Africa
Population: 
Adults
Families and carers
Disability
Disorder: 
Psychosis/bipolar disorder
2871 reads