Strengthening Public Mental Health in Africa in Response to Covid-19

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, well-being 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 outbreak^2,3.

In order for the COVID-19 MHPSS response to be as effective as possible to protect population well-being at a national level, different actors in mental health need to be aware of the best available evidence and coordinate to pivot towards the delivery of these public mental health and psychosocial support interventions as quickly as possible. The 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 Centres for Disease Control and Prevention (Africa CDC), the West African Health Organisation (WAHO), the East, Central and Southern African Health Community (ECSA-HC), UK Health Security Agency and London School of Hygiene & Tropical Medicine (LSHTM). It combines research, capacity development and engagement activities in order to better understand and support the mental health response to the current COVID-19 pandemic in African countries. The research component aims to understand best practices and gaps in MHPSS aspects of the COVID-19 response at a national level, learn from embedded local actors about what can facilitate their work to close these gaps, and 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.

Impact summary

The outputs of the project include:

Assessment of the extension to which MHPSS activities were implemented in the COVID-19 Pandemic

The challenges and opportunities for MHPSS integration into COVID-19 response were identified

Providing recommendations for MHPSS actors to improve the MHPSS response to future public health emergencies including infectious disease outbreaks.

Organising a workshop in West Africa that brought together national mental health actors and mental health experts from African public health institutions to share experiences and lessons learned from COVID-19 and other emergencies in the continent

Reviewing the current evidence on MHPSS interventions in the contexts of infectious disease outbreaks (e.g. EVD, COVID-19)

Better collaboration between the key public health institutions in Africa (members of the project consortium), to strengthen public mental health in Africa.

Innovation details

The COVID-19 pandemic has had a massive impact on people’s mental health worldwide, with evidence that the prevalence of major depressive and anxiety disorders increased by a quarter in 2020 alongside high rates of reported distress ⁴. In a global survey of 130 countries conducted by the World Health Organization (WHO), 93% of the countries reported substantial disruption in their services for mental, neurological, and substance use disorders during the pandemic⁵. This is of particular concern given that mental health services in many countries were already fragile and poorly funded⁶. Although 89% of countries that responded to the previous WHO survey reported that MHPSS was part of their national COVID-19 response plans, only 17% had ensured that full additional funding is available for MHPSS activities⁵. This suggests a substantial gap exists between the planning for and implementation of MHPSS activities. Additionally, the extent to which those plans are implemented was not clear.

International normative guidance on MHPSS in the COVID-19 pandemic was developed quickly in the early months of the pandemic, in 2020. For instance, the Inter-Agency Standing Committee (IASC) Reference Group on MHPSS in Emergency Settings issued an interim briefing note to outline the MHPSS aspects of the COVID-19 outbreak³. This guidance outlined fourteen key activities that were recommended to be implemented as a part of the national COVID-19 response.

The research component of this project aims to (1) assess the extent to which the IASC recommended MHPSS activities were included in the national response to the COVID-19 pandemic in African countries and (2) explore barriers and enablers to MHPSS integration into the COVID-19 response.

Identifying challenges and opportunities for MHPSS integration into the COVID-19 response will provide evidence to inform preparedness and response to future infectious disease outbreaks and other public health emergencies in the continent.

An explanatory sequential mixed-methods study, using an online survey followed by in-depth interviews, was conducted with data collection taking place between October and December 2020. In this approach, initial quantitative results are followed up by more in-depth qualitative research to better understand quantitative results.

In order to obtain data on MHPSS response in African countries, we purposively selected Mental Health Focal Points in national Ministries of Health (MoH), WHO Regional and Country Offices, and staff of National Public Health Institutions to respond to the survey and to be interviewed. Civil society representatives were also included in the interviews to obtain information from different perspectives. The invitation to participate was sent via Africa Centres for Disease Control and Prevention (Africa CDC), West African Health Organisation (WAHO) and WHO Regional Office for Africa (AFRO), and WHO Regional Office for the Eastern Mediterranean (EMRO).

Findings from this research will help inform the capacity-building and system-strengthening components of the project.

Through this project, a consortium of Africa’s leading public health institutions was 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.

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

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.
WHO. Mental health and psychosocial considerations during the COVID-19 outbreak https://www.who.int/publications/i/item/WHO-2019-nCoV-MentalHealth-2020.1
Inter Agency Standing Committee. Briefing Note on Addressing Mental Health and Psychosocial Aspects of the COVID-19 Outbreak. IASC: Geneva, 2020
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.
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
Hann K, Pearson H, Valle C, Eaton J. Factors for Success in mental health advocacy in Sierra Leone. Global Health Action 2015, 8:28791

Research

Challenges and Opportunities for Mental Health and Psychosocial Support in the COVID-19 Response in Africa A Mixed-Methods Study.pdf

Multimedia

Comments

This is very innovative, one

Submitted by Michael Ede on Friday, 12th February 2021

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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London School of Hygiene and Tropical Medicine