Lesotho is a small, landlocked kingdom in South Africa with a population of 2 million people. There is a 25% prevalence of HIV in Lesotho2 and high prevalence of tuberculosis (TB) at 724/100,0001, 3. A study on the burden of mental illness conducted at PIH sites, using local data as well as from the Global Burden of Disease Study, showed that 32% of all Years Lived with Disability (YLDs) in Lesotho are attributable to mental illness6. This percentage is as great as all other YLDs due to non-communicable diseases in Lesotho combined6.
The aim of the Lesotho mental health program is to promote the integration of mental health care awareness and delivery among treatment supporters, counsellors, nurses and doctors, focusing on patients with high comorbidities of MDRTB and HIV/AIDS. Furthermore, people with infectious diseases such as HIV or TB are also likely to be affected by mental illness, often having depression as a comorbid condition2, 3. Given the high prevalence of infectious diseases in Lesotho, which require chronic care, integrating mental health care within infectious disease service delivery will allow mental health care to reach a significant percent of the population. Furthermore, given the strong MDR-TB program within Lesotho, depression screening will be integrated into the existing program and be done by village health workers and clinicians. The program will be aligned with the Ministry of Health’s goals and objectives for mental health care.
Services are being rolled out in 2018 for delivery in the PIH - Ministry of Health Hospital, Botsabelo in Maseru, at district hospital in Mohales’ hoek and seven PIH supported sites in the rural high mountains of Lesotho. Plans to develop a task-sharing model using district psychiatric nurses and general nurses and physicians, through support and supervision from specialists, are underway. The program will include medication management and targeted psychosocial interventions by village health workers, social workers, psychologists, nurses and general physicians. Village health workers were selected by local communities based on trust and a competency criteria given by the Ministry of Health. Case finding, engagement, follow up and psychoeducation will also be conducted as part of the implementation. Furthermore, the program is developing training curricula for village health workers and clinicians, building off existing materials developed by the PIH Haiti and Rwanda team. A monitoring and evaluation plan is also being developed that integrates mental health indicators, encounter tools and outcomes into the existing TB, HIV and CAMH data collection systems.
Trainings for providers (doctors, nurses and psychiatric nurses) were initiated in 2017 in Mohale’s Hoek district and in 2018 at the PIH/MOH Botsabelo Hospital in Maseru. Over a 4 day period, trainees engaged in lively discussion and interaction as they learned about mental health integration into primary care of their patients. Lecture, discussion and shared patient stories focused on:
- Detection and measures for depression (PHQ-9)
- Treatment for depression (including medication and talking therapy)
- Psychoeducation (including stigma and suicide)
- Family support
- Depression in vulnerable populations e.g. mothers, children and adolescents and geriatric patients
- Detoxification protocol for patients with alcohol abuse
- End of life and palliative care