Building capacity of health care workers and community members
The project primarily seeks to build the capacity of human resources in the health care system (Primary healthcare (PHC) workers) and the community members (Village Mental Health Team (VMHT)) by training them to identify and manage mental health problems in their own community supported by a Mobile Mental Health Team (MMHT) which provides outreach services.
The PHC health workers in Soroti District were invited for a five day training on management of common mental illness using WHO mhGAP adapted Intervention Guide. The common mental illnesses in post-conflict communities, like Soroti district, include: post-traumatic stress disorder (PTSD), depression, anxiety disorders, alcohol and drug abuse, Epilepsy, somatoform disorders and stress management. These health workers then manage mental illness in the units they work and are supported by the district mental health specialists. The mental health specialists also hold clinics at accessible community posts which were identified by service users. Treated patients are evaluated for quality of life at entry into care and after six months of follow up treatment.
In order to mobilize communities, improve knowledge and attitudes as well as deliver PFA to survivors of current traumatic events, community health workers (CHWs) were trained and mentored in the rural communities. The CHWs deliver the standardized Psychological First Aid model (more below).
The project has other three components which are complementary: mobile mental health clinics, Service Owned Users Pharmacy (SOUP) Medicines, and the Psychological First Aid (PFA) model.
Mobile Mental Health Clinics
Mobile Mental Health Clinics are defined as service user organised outreach clinics whereby service users gather and a team of health workers from the centralised clinic at the district hospital (MMHT) work together to provide clinical services to outreach rural patients, and at the same time train and supervise the village community who form the VMHT.
A team of health workers from the mental health clinic at Soroti Regional Referral Hospital comprising of Psychiatry Clinical Officers or Psychiatric Nurse and Counsellors travel and locate the VMHT members and service users at the outreach post on a designated mental health clinic day. The clinic day may be selected to coincide with a major community activity e.g. the market day.
Queuing service users, at the health clinics, participate in peer support sessions and group meetings in the form of peer-counselling sessions. Service users mobilise themselves and schedule these sessions.
Service Owned Users Pharmacy (SOUP) Medicines model
In order to increase accessibility of common mental health medicines, a SOUP Medicines model was initiated. In this model, mental health service users and their caregivers were asked to form groups through which members mobilized funds, saved and used them to buy medicines when the required medicines were not available in the public health units. Service users recognized that by raising funds beforehand and buying medicines as group, they would benefit from cheaper whole sale prices and that they would ensure continuity of treatment. The groups also helped them to support each other intermesh of treatment as well as increased productivity.
Psychological First Aid Model
An adaptation of the Psychological First Aid model to manage mental health problems in crisis situations in these rural communities where, often, there are no mental health workers.
Community education activities
Communities have been mobilized to participate in the project through education on radio, gatherings and household. The mental health specialists from the district, primary healthcare workers and CHWs have carried out public education.
Feasibility and Scale up
The intervention was first piloted in two sub-counties before scaling it up to a total of seven sub-counties.