Innovation summary

Capacity in public mental health policy and programming skills has been identified as a core priority for progress in health systems reform1. In the context of the COVID-19 outbreak, wellbeing is a central concern2. At the global level, the WHO, IASC and other agencies have provided clear guidance for public health responses at a national level to mitigate the likely mental health consequences of the outbreak3.

In order for the COVID-19 MHPSS  response to be as effective as possible to protect population wellbeing at a national level, different actors in mental health need to be aware of the best available evidence, and coordinated to pivot towards delivery of these public mental health and psychosocial support interventions as quickly as possible. World Health Organization guidance recommends a clear role for mental health leads in Ministries of Health, and over the past 10 years, mental health leads have increasingly been embedded in Ministries in Africa. The COVID-19 outbreak has highlighted the importance of this role, with specific technical knowledge and skills being a key contribution to national response efforts.

This project is a collaboration between the UK Public Health Rapid Support Team (UK-PHRST), WHO AFRO and EMRO, Africa CDC, the West African Health Organisation, the East, Central and Southern African Health Community (ECSA-HC) , Public Health England and LSHTM. It combines research, capacity building and engagement activities in order to better understand and support the mental health response to the current COVID-19 pandemic in 25 African countries. The research component aims to understand best practice and gaps in MHPSS aspects of the COVID-19 response at a national level, to learn from embedded local actors about what can facilitate their work to close these gaps, and to identify how capacity strengthening can be used as a tool to drive implementation of evidence-based response in the context of an epidemic emergency, and for longer-term system strengthening. Study participants will include national government mental health focal points, as well as partner agency and civil society mental health stakeholders, from 25 countries across Africa.

Impact summary

Participants will include key stakeholders from the Ministry of Health and National Public Health Institutes of 25 African countries.

The expected outputs of the project are:

  • a rapid assessment of best practice, gaps, barriers and enablers to integrating MHPSS within an outbreak response
  • the development and delivery of a capacity-building programme for mental health leaders in Africa to support the current MHPSS response to the COVID-10 epidemic
  • the establishment of a network for coordination and collaboration among public mental health leaders in the region, to build a foundation for future work to increase visibility and investment into public mental health within key institutions in Africa, as well as within the international development sector.

In the best of times, mental health is poorly funded. Even more neglected are the preventative and public health aspects of mental health. An effective response to the mental health impacts of COVID-19 needs to involve the whole of society, with a focus on prevention, integration and coordination across sectors.”

  

Dr Mohammed Abdulaziz, Head for Disease Control and Prevention, Africa CDC

Innovation details

The first phase of the research component will use a  questionnaire to assess the current status of the COVID-19 MHPSS response in participating countries against international standards, as defined by the 14 ‘Globally Recommended Activities’ in the 2020 IASC Briefing note. In Phase 2, in-depth qualitative work with a smaller sample of country stakeholders will explore barriers and enablers in order to identify the most appropriate means of providing support to public mental health leads for COVID-19 and outbreak response more broadly.

Findings from this research will help inform the capacity-building and system-strengthening components of the project. These include building a consortium of Africa’s leading public health institutions to guide research and use results to develop a common approach to strengthening the continent’s public mental health capacity, with a focus on strengthening capacity of national mental health focal points. This will be achieved through development and delivery of a programme focussing on technical, advocacy and leadership skills for mental health aspects of outbreak response, using online learning platforms, peer-learning, and mentorship.

Through this project, a consortium of Africa’s leading public health institutions will be established in order to guide research and build a foundation for future work to increase visibility and investment into public mental health within key institutions in Africa, as well as within the international development sector.

Results will be rapidly disseminated through links of consortium members, IASC MHPSS Reference Group, WHO and other agencies engaged in national-level, regional and global response.  Dissemination methods will include webinars and blogs supported by social media posts, a final report and academic publications.  A final face-to-face event is planned at Africa CDC/Africa Union in Addis Ababa, Ethiopia, to present research findings, consolidate networks established, and to promote mental health system strengthening as part of the emergency response to COVID-19, and as a part of longer-term processes of emergency preparedness, Disaster Risk Reduction and resilience building.

Key drivers

Research methods: The qualitative research will follow a two-stage approach, allowing for participants to contribute their perspectives without external imposition, but using an analysis process that will facilitate timely and relevant results that will feed into the overall aim of the research, and provide actionable conclusions. Analytic frameworks, such as the Consolidated Framework for Implementation Research (CFIR) , allow for greater comparability across contexts, and application to structured and practical processes of translation of research to practice5.

Networks: This projects builds from a series of consultation exercises with African mental health leaders in Burkina Faso (WAHO) and London (Wellcome) in November 2019, carried out by the LSHTM Centre for Global Mental Health, the Royal African Society and CBM Global (and international development NGO). Leaders highlighted the need to build a network of public mental health focal points across Africa to strengthen peer learning and support4. For this project, a consortium Africa’s leading public health institutions will be established in order to guide research, use results, and to develop a common approach to strengthening the continent’s public mental health capacity.

Capacity building: Consultation highlighted the importance of strengthening the capacity of mental health leaders in the context of COVID-19, as a means of addressing a recognised barrier to sufficient inclusion of mental health in emergency response as well as longer-term systems reform. Findings from the research phase of the project will shape the capacity-building programme, which will be delivered through the Mental Health Innovation Network and Rapid Support Team knowledge exchange platforms, and will include webinars, peer-learning and mentorship components.

Advocacy: The evidence generated, and new knowledge and skills acquired, will help to strengthen advocacy for parity of mental health within wider public health, services and emergency response. This work aims to enable regional and national mental health leaders to better articulate the value of a comprehensive integration of mental health into the plans for not only this crisis response, but the next phases of recovery, rebuilding and preparation for future epidemics6.

Challenges

Prioritisation and capacity to engage: Health system budgets and human resource capacity are already facing unprecedented strain due to the COVID-19 pandemic. In addition, mental health is generally a low public health priority, and mental health units in Ministries are often poorly resourced, and struggle to gain the political will to mobilise resources on a par with other health areas1. Project success relies on key stakeholders’ ability to engage, which depends on human and financial resources, as well as political will. Countries with the greatest capacity-building needs may prove the most difficult due to engage.

Coordination: Infrastructure linking national focal points for consistent coordination and learning is limited1. Such gaps result in difficulties in mounting a well organised and effective response to emergencies, including epidemics, despite learning in some parts of the continent, for example during the West African Ebola crisis, which might otherwise inform work in other countries5.

Partners

  • Africa CDC - Dr Mohammed Abdulaziz, Epidemiologist
  • WHO AFRO - Dr Florence Baingana, Regional Advisor, Mental Health 
  • WHO EMRO – Dr Khalid Saeed. Regional Advisor Mental Health 
  • West African Health Organisation - Dr William Bosu; Dr Namoudou Keita, Technical Officers
  • East, Central and Southern African: Rosemary Mwaisaka, NCD cluster lead
  • Public Health England: Ian Walker, Consultant in Global Public Health
  • London School of Hygiene and Tropical Medicine: Dr Julian Eaton, Assistant Professor at the Centre for Global Mental Health
  • UK Public Health Rapid Support Team: Dr Alice Walker, Mental Health Research Fellow

Funders

  • UKAID
  • UK Department of Health and Social Care
  • National Institute for Health Research (NIHR)

Impact details

This formative project, particularly the consortium and peer networks established within it, will provide the foundation for further efforts to strengthen MHPSS within emergencies, in addition to wider system strengthening in mental health across the continent.

So far, the consortium has adapted a Psychological First Aid module for use in African countries.. This course is available in multiple languages.

 

The course aims to help participants develop understanding of how emergencies like the coronavirus pandemic can affect mental wellbeing, and how to offer practical and emotional support to people in distress. This training programme will assist professionals, volunteers and members of the public in African countries to support their own and others’ psychological wellbeing during the COVID-19 pandemic, as well as being relevant for other emergency and crisis situations.

References

  1. Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, Sridhar D, Underhill C.Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet. 2007 Sep 29;370(9593):1164-74.
  2.  WHO.  Mental health and psychosocial considerations during the COVID-19 outbreak https://www.who.int/publications/i/item/WHO-2019-nCoV-MentalHealth-2020.1
  3. Inter Agency Standing Committee. Briefing Note on Addressing Mental Health and Psychosocial Aspects of the COVID-19 Outbreak. IASC: Geneva, 2020
  4. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi: 10.1186/1748-5908-4-50.
  5. Qureshi O, Eaton J. Mental Health in Africa: Briefing for the All Party Parliamentary Group for Africa. London, UK: Royal African Society and Mental Health Innovation Network, 2020
  6. Hann K, Pearson H, Valle C, Eaton J. Factors for Success in mental health advocacy in Sierra Leone. Global Health Action 2015, 8:28791

Comments

This is very innovative, one of the biggest stigma around mental health is government policies. As a member of support group of people with mental health lead experience in Nigeria. We have approached Corporate affair commission to have our organization register as a civil society group to advocate for the right of people with mental health live experience and how to lobby the government to improve treatment facilities for people with mental illness. The government have tossed the name out in all our attempt saying under Nigeria constitution, we are not eligible to enter any legal association due to mental health experience. Is mental health not illness, don't we have cure to mental sicknesses, be it Bipolar Affected Decease, Schizophrenia, or Major Depressive Disorder.
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