Browsing by Author "Flisher, Alan"
Now showing 1 - 8 of 8
Results Per Page
Sort Options
- ItemOpen AccessA situation analysis of mental health services and legislation in Ghana: challenges for transformation(2010) Ofori-Atta, A; Read, U M; Lund, Crick; Flisher, Alan; MHaPP Research Programme ConsortiumObjective: To conduct a situation analysis of the status of mental health care in Ghana and to propose options for scaling up the provision of mental health care. Method: A survey of the existing mental health system in Ghana was conducted using the WHO Assessment Instrument for Mental Health Systems. Documentary analysis was undertaken of mental health legislation, utilizing the WHO Legislation checklists. Semi-structured interviews and focus group discussions were conducted with a broad range of mental health stakeholders (n=122) at the national, regional and district levels. Results: There are shortfalls in the provision of mental health care including insufficient numbers of mental health professionals, aging infrastructure, widespread stigma, inadequate funding and an inequitable geographical distribution of services. Conclusion: Community-based services need to be delivered in the primary care setting to provide accessible and humane mental health care. There is an urgent need for legislation reform, to improve mental health care delivery and protect human rights.
- ItemOpen AccessAn assessment of mental health policy in Ghana, South Africa, Uganda and Zambia(BioMed Central Ltd, 2011) Faydi, Edwige; Funk, Michelle; Kleintjes, Sharon; Ofori-Atta, Angela; Ssbunnya, Joshua; Mwanza, Jason; Kim, Caroline; Flisher, AlanBACKGROUND: Approximately half of the countries in the African Region had a mental health policy by 2005, but little is known about quality of mental health policies in Africa and globally. This paper reports the results of an assessment of the mental health policies of Ghana, South Africa, Uganda and Zambia. METHODS: The WHO Mental Health Policy Checklist was used to evaluate the most current mental health policy in each country. Assessments were completed and reviewed by a specially constituted national committee as well as an independent WHO team. Results of each country evaluation were discussed until consensus was reached. RESULTS: All four policies received a high level mandate. Each policy addressed community-based services, the integration of mental health into general health care, promotion of mental health and rehabilitation. Prevention was addressed in the South African and Ugandan policies only. Use of evidence for policy development varied considerably. Consultations were mainly held with the mental health sector. Only the Zambian policy presented a clear vision, while three of four countries spelt out values and principles, the need to establish a coordinating body for mental health, and to protect the human rights of people with mental health problems. None included all the basic elements of a policy, nor specified sources and levels of funding for implementation. Deinstitutionalisation and the provision of essential psychotropic medicines were insufficiently addressed. Advocacy, empowerment of users and families and intersectoral collaboration were inadequately addressed. Only Uganda sufficiently outlined a mental health information system, research and evaluation, while only Ghana comprehensively addressed human resources and training requirements. No country had an accompanying strategic mental health plan to allow the development and implementation of concrete strategies and activities. CONCLUSIONS: Six gaps which could impact on the policies' effect on countries' mental health systems were: lack of internal consistency of structure and content of policies, superficiality of key international concepts, lack of evidence on which to base policy directions, inadequate political support, poor integration of mental health policies within the overall national policy and legislative framework, and lack of financial specificity. Three strategies to address these concerns emerged, namely strengthening capacity of key stakeholders in public (mental) health and policy development, creation of a culture of inclusive and dynamic policy development, and coordinated action to optimize use of available resources.
- ItemOpen AccessExplanatory models of mental disorders and treatment practices among traditional healers in Mpumalanga South Africa(2010) Sorsdahl, Katherine Rae; Flisher, Alan; Wilson, Z; Stein, DanObjective: In many traditional belief systems in Africa, including South Africa, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these causes. However, there is limited information on their explanatory models and consequent treatment practices. The present study examines traditional healers’ explanatory models (EMs) and treatment practices for psychotic and non-psychotic mental illnesses.Method: 4 focus group discussions (8 healers in each group) and 18 in-depth interviews were conducted. Four vignettes were presented (schizophrenia, depression, panic and somatization) and traditional healers’ views on the nature of the problem, cause, consequence, treatment and patient expectations were elicited. Results: Traditional healers held multiple explanatory models for psychotic and non-psychotic disorders. Psychotic illnesses appear to be the main exemplar of mental illness and were treated with traditional medicine, while nonpsychotic illnesses were not viewed as a mental illness at all.Additionally, traditional healers do not only use herbs and substances solely from “traditional” sources but rather have incorporated into their treatment practices modern ingredients that are potentially toxic. Conclusion:Interventions aimed at increasing the mental health literacy of traditional healers are essential. In addition, investigations of the effectiveness of traditional healer treatment for psychiatric disorders should be conducted.
- ItemOpen AccessFrom mental health policy development in Ghana to implementation: What are the barriers?(2010) Awenva, A D; Read, U M; Ofori-Attah, A L; Doku, V C K; Akpalu, B; Flisher, Alan; Lund, Crick; Osei, A O; Flisher, A J; MHaPP Research Programme ConsortiumObjective: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. Method: The study used both quantitative and qualitative methods. Quantitatively, the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the content of mental health policy, plans and legislation in Ghana. Qualitative data was gathered using in-depth interviews and focus group discussions with key stakeholders in mental health at the macro, meso and micro levels. These were used to identify barriers to the implementation of mental health policy, and steps to overcoming these. Results: Barriers to mental health policy implementation identified by participants include: low priority and lack of political commitment to mental health; limited human and financial resources; lack of intersectoral collaboration and consultation; inadequate policy dissemination; and an absence of research-based evidence to inform mental health policy. Suggested steps to overcoming the barriers include: revision of mental health policy and legislation; training and capacity development and wider consultation. Conclusion: These results call for well-articulated plans to address the barriers to the implementation of mental health policy in Ghana to reduce the burden associated with mental disorders.
- ItemOpen AccessIntegrating mental health into primary health care in Zambia: a care provider's perspective(BioMed Central Ltd, 2010) Mwape, Lonia; Sikwese, Alice; Kapungwe, Augustus; Mwanza, Jason; Flisher, Alan; Lund, Crick; Cooper, SaraBACKGROUND:Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services.AIMS:The aim of this paper was to explore health providers' views about mental health integration into primary health care. METHODS: A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). RESULTS: There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems.RECOMMENDATIONS:It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. CONCLUSION: Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia.
- ItemOpen AccessMental illness - stigma and discrimination in Zambia(2010) Kapungwe, A; Cooper, Sara; Mwanza, J; Mwape, L; Sikwese, A; Kakuma, R; Lund, Christopher; Flisher, Alan; MHaPP Research Programme ConsortiumObjective: The aim of this qualitative study was to explore the presence, causes and means of addressing individual and systemic stigma and discrimination against people with mental illness in Zambia. This is to facilitate the development of tailor-made antistigma initiatives that are culturally sensitive for Zambia and other low-income African countries. This is the first in-depth study on mental illness stigma in Zambia. Method: Fifty semi-structured interviews and 6 focus group discussions were conducted with key stakeholders drawn from 3 districts in Zambia (Lusaka, Kabwe and Sinazongwe). Transcripts were analyzed using a grounded theory approach. Results: Mental illness stigma and discrimination is pervasive across Zambian society, prevailing within the general community, amongst family members, amid general and mental health care providers, and at the level of government. Such stigma appears to be fuelled by misunderstandings of mental illness aetiology; fears of contagion and the perceived dangerousness of people with mental illness; and associations between HIV/AIDS and mental illness. Strategies suggested for reducing stigma and discrimination in Zambia included education campaigns, the transformation of mental health policy and legislation and expanding the social and economic opportunities of the mentally ill. Conclusion: In Zambia, as in many other lowincome African countries, very little attention is devoted to addressing the negative beliefs and behaviours surrounding mental illness, despite the devastating costs that ensue. The results from this study underscore the need for greater commitment from governments and policy-makers in African countries to start prioritizing mental illness stigma as a major public health and development issue.
- ItemOpen AccessPsychiatric emergency service users at Groote Schuur Hospital(AOSIS, 2005) Wilson, Don; Flisher, Alan; Welman, WelmanObjective. To document and compare the characteristics of patients assessed at a psychiatric emergency service (PES) during April and May of 1988 and 1998. Design. Two cross-sectional surveys. Setting. Groote Schuur Hospital (GSH), Cape Town. Subjects. Patients assessed at the PES, GSH. Outcome measures. These were occupational status, referral source, distance travelled to get to the hospital, and diagnosis. Results. Nine hundred and twenty-five patients made 1 081 visits to the unit during a 2-month period in 1988, while during a similar period in 1998, 364 patients made 477 visits. In the latter period the patients were significantly more likely to be skilled workers or students/scholars, to be referred from within GSH or other health facilities, to have travelled less than 10 km to get to the hospital, and to be suffering from a mood disorder or suicidality (and less likely to be suffering from a substance use disorder). Conclusions. The differences between the two time periods indicate that changes in policy during the period 1988 - 1998 may have impacted on the patient profile at the PES at GSH. It is important to document such changes with a view to informing service planning for both tertiary referral centres and other levels of care.
- ItemOpen AccessStakeholder's perceptions of help-seeking behaviour among people with mental health problems in Uganda(BioMed Central Ltd, 2011) Nsereko, James; Kizza, Dorothy; Kigozi, Fred; Ssebunnya, Joshua; Ndyanabangi, Sheila; Flisher, Alan; Cooper, Sara; MHaPP Research Programme ConsortiumINTRODUCTION: Mental health facilities in Uganda remain underutilized, despite efforts to decentralize the services. One of the possible explanations for this is the help-seeking behaviours of people with mental health problems. Unfortunately little is known about the factors that influence the help-seeking behaviours. Delays in seeking proper treatment are known to compromise the outcome of the care.AIM:To examine the help-seeking behaviours of individuals with mental health problems, and the factors that may influence such behaviours in Uganda. METHOD:Sixty-two interviews and six focus groups were conducted with stakeholders drawn from national and district levels. Thematic analysis of the data was conducted using a framework analysis approach. RESULTS: The findings revealed that in some Ugandan communities, help is mostly sought from traditional healers initially, whereas western form of care is usually considered as a last resort. The factors found to influence help-seeking behaviour within the community include: beliefs about the causes of mental illness, the nature of service delivery, accessibility and cost, stigma. CONCLUSION: Increasing the uptake of mental health services requires dedicating more human and financial resources to conventional mental health services. Better understanding of socio-cultural factors that may influence accessibility, engagement and collaboration with traditional healers and conventional practitioners is also urgently required.