Browsing by Author "Lund, C"
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- ItemRestrictedA retrospective evaluation of a wilderness-based leadership development programme(2011) Draper, C E; Lund, C; Flisher, A JThe Leadership Project (LP) in Cape Town, South Africa, is a wilderness-based leadership development programme that targets young people from diverse backgrounds. The aim of this study was to evaluate the LP, focusing on process and perceived outcomes. Document analysis and key informant interviews were used to evaluate programme reach and implementation process. Semi-structured interviews and focus groups with past programme participants (n = 46) were conducted to assess perceived outcomes. Study findings indicated that the LP offers a relevant programme and has wide reach through its range of client agencies and organisations. Qualitative findings highlighted that participants' positive experiences and views of the LP came about through the interaction between 'self', 'others'and the 'environment'. Participants' perceived intrapersonal and interpersonal outcomes of the LP aligned with the LP's intended outcomes. Mechanisms of perceived outcomes - leaders, programme activities and programme setting - influenced and facilitated the reflective process. This reflective process (strongly related to the intrapersonal outcome of increased self-awareness) appeared to underlie the interpersonal outcomes of the LP. Therefore, a significant finding of this study was that awareness of self is a key characteristic of leadership development. The nature of perceived outcomes was underpinned by the changing of perspectives, and the LP was described as either starting or contributing to a process of change, or as a life changing experience. No major improvements to the LP were suggested, but rather participants' responses affirmed the content and delivery of the programme. These findings indicate that a study with a relatively small scope can provide insight into the perceived outcomes of a leadership development programme, particularly one that caters for participants from a diverse range of cultural and socioeconomic backgrounds. The findings have elucidated the manner in which interpersonal outcomes are underpinned by intrapersonal outcomes, and the complexity of these outcomes in terms of assessment.
- ItemOpen AccessAttitudes of primary health care providers towards people with mental illness: evidence from two districts in Zambia(2011) Kapungwe, A; Cooper, S; Mayeya, J; Mwanza, J; Mwape, L; Sikwese, A; Lund, C; Mental Health and Poverty Project Research Programme ConsortiumThe aim of this study was to explore health care providers’ attitudes towards people with mental illness within two districts in Zambia. It sought to document types of attitudes of primary health care providers towards people suffering from mental illness and possible predictors of such attitudes. This study offers insights into how health care providers regard people with mental illness that may be helpful in designing appropriate training or re-training programs in Zambia and other low-income African countries. Method: Using a pilot tested structured questionnaire, data were collected from a total of 111 respondents from health facilities in the two purposively selected districts in Zambia that the Ministry of Health has earmarked as pilot districts for integrating mental health into primary health care. Results: There are widespread stigmatizing and discriminatory attitudes among primary health care providers toward mental illness and those who suffer from it. These findings confirm and add weight to the results from the few other studies which have been conducted in Africa that have challenged the notion that stigma and discrimination of mental illness is less severe in African countries. Conclusion: There is an urgent need to start developing more effective awareness-raising, training and education programmes amongst health care providers. This will only be possible if there is increased consensus, commitment and political will within government to place mental health on the national agenda and secure funding for the sector. These steps are essential if the country is improve the recognition, diagnosis and treatment of mental disorders, and realize the ideals enshrined in the progressive health reforms undertaken over the last decade.
- ItemOpen AccessChallenges faced by South African health services in implementing the Mental Health Care Act(Health & Medical Publishing Group, 2007) Lund, C; Stein, Dan J; Flisher, A J; Mehtar, SThe World Health Organization (WHO) has drawn attention to the growing global burden of mental disorders, and to recent advances in our understanding of and ability to treat these disorders. Mental disorders accounted for 12% of the global burden of disease in 2000. This figure will rise to 15% in 2020, when it is estimated that unipolar depression will be the second most disabling health condition in the world. In South Africa, neuropsychiatric disorders account for the second highest proportion of the local burden of disease, after HIV/AIDS.
- ItemOpen AccessImpact of integrated district level mental health care on clinical and functioning outcomes of people with depression and alcohol use disorder in Nepal: a non-randomised controlled study(2020-09-14) Jordans, M J D; Garman, E C; Luitel, N P; Kohrt, B A; Lund, C; Patel, V; Tomlinson, MAbstract Background Integration of mental health services into primary healthcare is proliferating in low-resource countries. We aimed to evaluate the impact of different compositions of primary care mental health services for depression and alcohol use disorder (AUD), when compared to usual primary care services. Methods We conducted a non-randomized controlled study in rural Nepal. We compared treatment outcomes among patients screening positive and receiving: (a) primary care mental health services without a psychological treatment component (TG); (b) the same services including a psychological treatment (TG + P); and (c) primary care treatment as usual (TAU). Primary outcomes included change in depression and AUD symptoms, as well as disability. Disability was measured using the 12-item WHO Disability Assessment Schedule. Symptom severity was assessed using the 9-item Patient Health Questionnaire for depression, the 10-item Alcohol Use Disorders Identification Test for AUD. We used negative binomial regression models for the analysis. Results For depression, when combining both treatment groups (TG, n = 77 and TG + P, n = 60) compared to TAU (n = 72), there were no significant improvements. When only comparing the psychological treatment group (TG + P) with TAU, there were significant improvements for symptoms and disability (aβ = − 2.64; 95%CI − 4.55 to − 0.74, p = 0.007; aβ = − 12.20; 95%CI − 19.79 to − 4.62; p = 0.002, respectively). For AUD, when combining both treatment groups (TG, n = 92 and TG + P, n = 80) compared to TAU (n = 57), there were significant improvements in AUD symptoms and disability (aβ = − 15.13; 95%CI − 18.63 to − 11.63, p < 0.001; aβ = − 9.26; 95%CI − 16.41 to − 2.12, p = 0.011; respectively). For AUD, there were no differences between TG and TG + P. Patients’ perceptions of health workers’ skills in common psychological factors were associated with improvement in depression patient outcomes (β = − 0.36; 95%CI − 0.55 to − 0.18; p < 0.001) but not for AUD patients. Conclusion Primary care mental health services for depression may only be effective when psychological treatments are included. Health workers’ competencies as perceived by patients may be an important indicator for treatment effect. AUD treatment in primary care appears to be beneficial even without additional psychological services.
- ItemOpen AccessMental Health Services in South Africa: Taking stock(2012) Lund, C; Petersen, Inge; Kleintjes, S R; Bhana, ArvinThere is new policy commitment to mental health in South Africa, demonstrated in the national mental health summit of April 2012. This provides an opportunity to take stock of our mental health services. At primary care level key challenges include- training and supervision of staff in the detection and management of common mental disorders, and the development of community-based psychosocial rehabilitation programmes for people with severe mental illness (in collaboration with existing non-governmental organizations). At secondary level, resources need to be invested in 72-hour observation facilities at designated district and regional hospitals, in keeping with the Mental Health Care Act. At tertiary level, greater continuity of care with primary and secondary levels is required to prevent “revolving door” patterns of care. There are major challenges and also opportunities related to the high level of comorbidity between mental illness and a range of other public health priorities, notably HIV/AIDS, cardiovascular disease and diabetes. The agenda for mental health services research needs to shift to a focus on evaluating interventions. With current policy commitment, the time to act and invest in evidence-based mental health services is now.
- ItemOpen AccessMental Health Stigma: What is being done to raise awareness and reduce stigma in south Africa?(2010) Kakuma, Ritsuko; Kleintjies, Sharon Rose; Lund, C; Drew, N; Green, AObjective: Stigma plays a major role in the persistent suffering, disability and economic loss associated with mental illnesses. There is an urgent need to find effective strategies to increase awareness about mental illnesses and reduce stigma and discrimination. This study surveys the existing anti-stigma programmes in South Africa. Method: The World Health Organization’s Assessment Instrument for Mental Health Systems Version 2.2 and semi-structured interviews were used to collect data on mental health education programmes in South Africa. Results: Numerous anti-stigma campaigns are in place in both government and non-government organizations across the country. All nine provinces have had public campaigns between 2000 and 2005, targeting various groups such as the general public, youth, different ethnic groups, health care professionals, teachers and politicians. Some schools are setting up education and prevention programmes and various forms of media and art are being utilized to educate and discourage stigma and discrimination. Mental health care users are increasingly getting involved through media and talks in a wide range of settings. Yet very few of such activities are systematically evaluated for the effectiveness and very few are being published in peer-review journals or in reports where experiences and lessons can be shared and potentially applied elsewhere. Conclusion: A pool of evidence for anti-stigma and awareness-raising strategies currently exists that could potentially make a scientific contribution and inform policy in South Africa as well as in other countries.
- ItemOpen AccessThe perceived impact of a relative's mental illness on the family members, their reported coping strategies and needs : a Zimbabwean study(2013) Marimbe-Dube, Bazondile; Lund, C; Cowan, FAim of the study is to explore the perceived impact of mental illness, reported coping strategies and reported needs of family members of mentally ill patients attending the Parirenyatwa Annexe Psychiatry Unit in Harare, Zimbabwe.
- ItemRestrictedThe prevalence of mental disorders among children, adolescents and adults in the Western Cape, South Africa(AOSIS, 2006) Kleintjies, S; Flisher, A J; Fick, M; Railon, A; Lund, C; Molteno, C; Robertson, B AObjective: To provide estimates of the prevalence of selected mental disorders in the Western Cape, based on the consensus achieved by a working group established for this purpose. Method: An expert working group was established to provide technical expertise for the project. Potential risk factors likely to influence local prevalence rates were identified. Annual prevalence rates for adults and for children and adolescents were derived by consensus, informed by a systematic literature review. Prevalence rates were derived for individual disorders and adjusted for comorbidity. Results: The overall prevalence was 25.0% for adults and 17.0% for children and adolescents. Conclusion: Prevalence rates of child, adolescent and adult mental disorders were derived in a short period of time and with the use of minimal resources. Although of unknown validity, they are useful for policy development and for planning service utilisation estimates, resource costing and targets for service development for local mental health needs. This in the absence of an existing methodologically sound national prevalence study. We recommend that policy and programme developers draw on the expertise of local academics and clinicians to promote research-informed planning and policy development in the public sector.
- ItemOpen AccessScaling up community-based services and improving quality of care in the state psychiatric hospitals: the way forward for Ghana(2010) Akpalu, B; Lund, C; Doku, V; Ofori-Atta, A; Osei, A; Ae-Ngibise, K; Awenva, D; Cooper, Sara Daniella; Flisher, J A; MHAPP Research Programme ConsortiumObjective: This paper aims to explore the options available for developing community-based care and improving the quality of care in psychiatric hospitals in Ghana. Method: Semi-structured interviews (SSIs) and focus group discussions (FGDs) were conducted with a cross-section of stakeholders including health professionals, researchers, policy makers, politicians, users and carers. The SSIs and FGDs were recorded digitally and transcribed verbatim. Apriori and emergent themes were coded and analysed with NVivo version 7.0, using a framework analysis. Results: Psychiatric hospitals in Ghana have a mean bed occupancy rate of 155%. Most respondents were of the view that the state psychiatric hospitals were very congested, substantially compromising quality of care. They also noted that the community psychiatric system was lacking human and material resources. Suggestions for addressing these difficulties included committing adequate resources to community psychiatric services, using psychiatric hospitals only as referral facilities, relapse prevention programmes, strengthening psychosocial services, adopting more precise diagnoses and the development of a policy on long-stay patients. Conclusion: There is an urgent need to build a credible system of community-based care and improve the quality of care in psychiatric hospitals in Ghana.