Innovation summary

In rural Nigerian areas, high levels of stigma and lack of mental health awareness creates a negative environment for people seeking access to mental healthcare1-2. In response to the growing needs of a large homeless population with severe mental health problems, a local community-based team led by a religious institution began offering mental health services in the area3.

The Edawu centre provides treatment and rehabilitation for homeless populations with mental health conditions. Since their launch in 1996, they have engaged in:

  • Mental health promotion and awareness in the local communities
  • Encouraged increased interaction and engagement of community members with homeless populations
  • Identify, provide treatment for and rehabilitate homeless populations with mental health conditions
  • Provided treatment for mental health conditions in the general community

In an attempt to streamline the service delivery component of care the Edawu centre provides, they collaborated with UK-based partners to deliver a training workshop on mhGAP 2.0 for their staff. The training built on previous foundations of the Edawu Centre’s work and also provided manuals for future use.  

Impact summary

  • Six staff members participated in the mhGAP training, including one community psychiatric nurse, a chief welfare officer and four community health officers
  • The Edawu Centre serves an in-patient population of approximately 40 individuals per week with mental health conditions
  • Individuals with mental health conditions are given treatment at the centre and attempts to reconnect them with their families are made.
  • Some service-users of the program were also offered employment at the Edawu centre after their rehabilitation

"The centre brings to the heart of rural Nigeria the importance of ‘No health without mental health’. In a land where the mentally ill are taken to be possessed, cursed and often abandoned, Edawu is a place of care, treatment and awareness."

-Nandini Chakraborty, Clinical Lead for the Nigeria International Links Project (Leicestershire Partnership NHS Trust)

Innovation details

Given the prevailing stigma and lack of awareness of mental illness in the region, it is not un-common to see people with mental health disorders in Edawu being chained, whipped, mistreated and becoming homeless as a result3.  The Edawu Community Mental Health Care Project was established in 1996 to address the growing needs of people with mental health conditions. The project oversees a community psychiatric programme (CPP) which includes clinical practice and focus on providing in-patient care and rehabilitation for homeless people with follow-up after discharge.

Edawu has a strong partnership with ACCEPT, a UK mental health charity and the Leicestershire Partnership NHS Trust (LPT). Practitioner visits from LPT have been ongoing to Edawu community mental health centre in Benue State of Nigeria on an annual basis since 2004 as part of the THET established international links projects5. Over the years, professionals from both medical and nursing streams have visited Edawu and trained staff in assessment and management of mental disorders.

In 2015, Edawu devised a strategy for the early identification of mental illness within its communities following the principles of community-based rehabilitation (CBR)4. This strategy involved the delivery of the mhGAP training manual (version 2.0) through facilitated staff workshops at Edawu3 with a focus on:

  • Developing a community mental health awareness programme
  • Psychiatric history-taking
  • Identification, diagnosis and treatment plans

The workshops took place in the span of two weeks and staff members were provided manuals and other training materials for use for future. This training built upon and consolidated training lectures from previous years and was implemented using a combination of role-playing, workshops and lectures using a total of around 20 hours of training. The staff receives supervision from its UK based partners on a monthly basis through web-based calls (SkypeTM).

Key drivers

Leadership
  • Very Reverend John Angwa, a priest at the Methodist Church of Nigeria has provided inspirational leadership and local ownership to the project since 2001
Partnerships

Aidan Lucas, an occupational therapist set the foundations of Edawu in in 2000. A prior employee of Leicestershire Partnership NHS Trust, he was instrumental in setting up the link between LPT and Edawua and provided support to continue the successful collaboration

Challenges

Connectivity issues

  • Successful implementation of mhGAP at Edawu following the training will require regular supervision and appropriate IT support is crucial to support this.

  • The Edawu project only has one laptop with access to an internet connection through a cellular sim card. Mobile internet in rural areas like Edawu can often be fragile and unpredictable.
Recruitment and staff turnover
  • The remote location of the project while increasing coverage of mental health services in rural areas of Nigeria also makes it difficult to attract qualified staff who may be used to urban lifestyles
  • More experienced staff are likely to leave for better opportunities in urban areas leading to high rates of staff turnover
Sustainability
  • Limited resources for mental health treatment provision (e.g. medicines and staff) in remote areas like Edawu, can create challenges in implementing mhGAP treatment plans in the long run

Continuation

The project aims to expand its coverage geographically through the recruiting of more clinics in the coming years. Their plans also include integrating their services into the agricultural sector to promote engagement for people in need of rehabilitative activities as well as to provide the finances to support continued programme activities.

Partners

Funders

  • Wesley Guild
  • ACCEPT, a mental health charity
  • Methodist Church Nigeria, Wesley House, 21/22 Marina, Lagos, Nigeria

Evaluation methods

The programme will review service statistics and looking at the diagnostic profile in a year’s time to measure improvements with the introduction of the mhGAP training. The results of the evaluation will be available in 2019. The centre also administers questionnaires to measure the individuals’ subjective perspective of improvement.

Cost of implementation

Cost of training

The full cost of conducting mhGAP training sessions to members of the Edawu staff over two weeks was approximately $2846 or 1,021,800 Nigerian Naira.

Annual cost of implementation

The annual cost for running the community mental health program at Edawu (including staff cost, drug procurement, transport, office maintenance and rent) is approximately $33,510 or 12,030,300 Nigerian Naira per year.

Impact details

  • The centre has rehabilitated over 10,000 People suffering from mental illness people over 20 years and increased the awareness of mental health in the local area.
  • The number of homeless people roaming the local market has reduced and is now a rarer sight
  • Approximately 20 people who were previously homeless were trained in various vocational and empowerment skills and now lead productive lives

References

  1. Gureje O, Lasebikan VO, Ephraim-Oluwanuga O, Olley BO, Kola L (2005) Community study of knowledge of and attitude to mental illness in Nigeria. The British Journal of Psychiatry, 186(5):436-41 [Link]
  2. Gureje O, Lasebikan VO (2006) Use of mental health services in a developing country. Social Psychiatry and Psychiatric Epidemiology, 1;41(1):44-9 [Link]
  3. Chakraborty N et al. (2017) Edawu: a journey from in-patient rehabilitation to community-based treatment and rehabilitation in Nigeria. BJPsych International, 14: 66-69. [Link]
  4. Adaka TA, Florence OB, Ikwem E (2014) Implementation of community-based rehabilitation in Nigeria: the role of family of people with disabilities. International Journal of Technology and Inclusive Education, 1, 2 (special issue) [Link]
  5. Tropical Health & Education Trust (THET) Health Partnership Scheme [Link]

Research

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