Service user involvement in mental health system strengthening in a rural African setting: qualitative study

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dc.contributor.authorHanlon, Charlotte
dc.date.accessioned2021-10-08T06:54:47Z
dc.date.available2021-10-08T06:54:47Z
dc.date.issued2017
dc.description.abstractBACKGROUND: It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. METHODS: Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. RESULTS: All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. CONCLUSION: As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.
dc.identifier.apacitationHanlon, C. (2017). Service user involvement in mental health system strengthening in a rural African setting: qualitative study. <i>BMC Psychiatry</i>, 17(1), 174 - 177. http://hdl.handle.net/11427/34339en_ZA
dc.identifier.chicagocitationHanlon, Charlotte "Service user involvement in mental health system strengthening in a rural African setting: qualitative study." <i>BMC Psychiatry</i> 17, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34339en_ZA
dc.identifier.citationHanlon, C. 2017. Service user involvement in mental health system strengthening in a rural African setting: qualitative study. <i>BMC Psychiatry.</i> 17(1):174 - 177. http://hdl.handle.net/11427/34339en_ZA
dc.identifier.issn1471-244X
dc.identifier.ris TY - Journal Article AU - Hanlon, Charlotte AB - BACKGROUND: It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. METHODS: Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. RESULTS: All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. CONCLUSION: As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated. DA - 2017 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Psychiatry LK - https://open.uct.ac.za PY - 2017 SM - 1471-244X T1 - Service user involvement in mental health system strengthening in a rural African setting: qualitative study TI - Service user involvement in mental health system strengthening in a rural African setting: qualitative study UR - http://hdl.handle.net/11427/34339 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34339
dc.identifier.vancouvercitationHanlon C. Service user involvement in mental health system strengthening in a rural African setting: qualitative study. BMC Psychiatry. 2017;17(1):174 - 177. http://hdl.handle.net/11427/34339.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Psychiatry and Mental Health
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Psychiatry
dc.source.journalissue1
dc.source.journalvolume17
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12888-017-1352-9
dc.subject.otherEthiopia
dc.subject.otherMental health
dc.subject.otherQualitative study
dc.subject.otherService user and carer involvement
dc.titleService user involvement in mental health system strengthening in a rural African setting: qualitative study
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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