Strengthening Inclusive Community Based Mental Health support
Strengthening Inclusive Community Based Mental Health support
Background
Globally mental health has come to the center of focus within the general health promotion since the beginning of the millennium. It is because different critical events posing threat to the persons overall wellbeing, creating stress and leading to mental health problems. The WHO World Mental Health (WMH) surveys on the global burden of mental disorders revealed an alarming scenario with a collective prevalence of anxiety, mood and behavioral disorders, and other mental health problems contributing up to 13% to the global burden of disease (The global burden of disease: 2004 update).
Around 450 million people are currently suffering from different mental disorders. It is estimated that about 70% of the global burden (caused by mental and neurological disorders, and substance use) occurs in low to middle-income countries. On the other hand, the number of health professional globally is very low, which can be translated as that majority of the persons with mental health needs do not receive any support or services and remain unserved. This is why there is a need to look for alternative ways or approaches to reach these unserved populations.
The mental health scenario in Bangladesh
Bangladesh has made remarkable progress in many indices over the years amid the growing population. We have seen an innovative approach to take the primary health care services at the people’s doorsteps through the community clinics. But, unfortunately mental health related services are not being included in this process. Hence, persons requiring mental health related services remain excluded and their conditions get worse. According to the national mental health survey report, 2018 , 18.7% of adults and 12.6% children in Bangladesh are affected with mental health problems. Among them, about 92% are not seeking mental health support due to multiple reasons e.g. scarcity of professionals, cost, distance, stigma etc.
The budget specially allocated for mental health service provision is very poor. Moreover, uneven distributed mental health service providers made the condition even more critical. Persons with disabilities and disadvantaged people living in the community are more vulnerable to mental health problems and faces more barriers to access the required services also. Persons with disabilities are more prone to mental health difficulties due to depression, loneliness, and lower life satisfaction compared to the general population. In this backdrop, CDD and UNESCAP took up a project together to pilot an approach for ensuring inclusive mental health support at the community level.
Introduction to Implementing Agencies
UNESCAP
The Economic and Social Commission for Asia and the Pacific (ESCAP) is the most inclusive intergovernmental platform in the Asia-Pacific region. The Commission promotes cooperation among its 53 member States and 9 associate members in pursuit of solutions to sustainable development challenges. ESCAP is one of the five regional commissions of the United Nations.
The ESCAP secretariat supports inclusive, resilient and sustainable development in the region by generating action-oriented knowledge, and by providing technical assistance and capacity-building services in support of national development objectives, regional agreements and the implementation of the 2030 Agenda for Sustainable Development. ESCAP also provides support to partners at the national level. ESCAP’s national offer is rooted in and linked with the implementation of global and regional intergovernmental frameworks, agreements, and other instruments (https://www.unescap.org/our-work -accessed on February 1, 2022 at 10:57 am).
Centre for Disability in Development (CDD)
Centre for Disability in Development (CDD) is a not-for-profit organization established in 1996. CDD has been working to ensure an inclusive society for persons with disabilities through their active participation. CDD emphasizes promoting and enjoyment of equal rights and opportunities of persons with disabilities. CDD has been promoting mental health support since 2015 through community-based initiatives in its project locations. CDD categorically believes in the full participation as well as contribution to society by persons with disabilities, if they are equipped with access to basic healthcare, psychosocial services, and support of others, including family members.
CDD’s mental health related initiative includes organizing outreach mental health camps, referring to specialized healthcare institutions, regular follow-up, increasing mental health literacy through organizing awareness sessions, capacity development of the stakeholders, and observing mental health days.
Short description of the Project
The “Protecting and Empowering Persons with Disabilities in the Context of COVID-19 Pandemic Project” aimed to promote inclusive community-based mental health services for persons with disabilities in the project locations to protect their mental well-being in the context of the COVID-19 pandemic. Through the project the community based mental health service approach was piloted with the participation of Organizations of Persons with Disabilities (OPDs), persons with disabilities themselves and the community members.
CDD introduced Peer Responders to ensure mental health support at the community level, CDD is the first agency, who developed and implemented this approach. In this journey, CDD received support from National Institute of Mental Health (NIMH) and individual professionals (psychiatrist and psychologist).
Peer Responders are persons with disabilities from the community who were trained to respond to people with mental health conditions. They are called peer responders because they are from the particular locations and considered as peers to the community. They received training to respond to the people with basic counseling skills. Peer Responders created awareness through mental health Camp, regular awareness building activities, for example- regular courtyard meetings, group sessions, and also carried out advocacy activities. They referred and followed-up critical cases who needed advanced and professional support. To ensure the continuity of the services, a Hotline was created.
Some notable achievement through project
- 1442 people including 772 persons with disabilities received mental health support by the peer responders through door-to-door visits, group sessions, and tele-services. Among them, 381(49.35%) were women and 391(50.65%) were men.
- 20 peer responders were trained on peer responding and are working as peer responders in 9 catchment areas, among them 7 are male and 13 are female. Among the 20 peer responders, 14 are persons with disabilities.
- 685 community people participated in awareness sessions where the number of persons without disabilities were 324 and persons with disabilities were 361.
- 510 persons with mental health needs have been referred to the nearby hospitals including NIMH for better treatment. Among them, 181 persons (35.49%) visited the hospitals at their respective project locations to seek advanced services.
- 149 people received advanced mental health services by expert psychologist. Among them, 55 were persons with disabilities.
- 132 people were assessed and diagnosed through 4 community level consultation camps. Among them, 116 were person with disabilities. Highest numbers of persons came with different anxiety-based disorders (40.74%), Neurodevelopmental disorders were the 2nd most prevalent disorder.
Learning from the project
While implementing the project, some learning were gained. Following are a few worth-mentioning learning of the project:
- Community-driven intervention is an effective strategy for social inclusion of persons with mental health needs.
- In order to create sustainable resource-poll in the community, it is essential to develop skilled peer-responders.
- Awareness at individual, family and community level is crucial to facilitate inclusion and promote mental health services.
- Needs of mental health care among the community people are immense and services need to be made accessible.
- If mental health services are supported by the local government agencies, it can support to ensure sustainability of the services.
Recommendation to implement Inclusive Community Based Mental Health support
- Community-driven inclusive mental health services should be introduced as a useful strategy in the face of growing mental health problems and amid the shortage of resources;
- Action should be taken to develop para professionals (peer responders) by selecting them from various groups, including people with disabilities through proper training on identifying mental health problems and providing primary mental health support;
- Existing human resources (health workers, CPP volunteers, EPI, CHCP, CG, CSG, teachers, religious leaders) should be trained on community based mental health to make the services available in the community;
- Services, such as physiotherapy, occupational therapy, and speech and language therapy needs to be increased to ensure overall well-being of people in needs including caregivers;
- Setting up a dedicated hotline number for accessing mental health professionals will help to ensure mental health support when seeing them in person will be difficult;
- Integration of mental health related issues in the existing health promotion campaigns will promote the increase of mental health literacy and reduce stigma as well as discrimination;
- Steps should be taken to integrate inclusive community-based mental health services into the primary health care system to ensure mental health care across the country at the community level;
- Different ministry (i.e. disaster, education) can plan to allocate some budget to address the mental health needs.
Conclusion
Although the mental health issues are on the increase, yet the COVID-19 pandemic has accelerated the negative impacts of this issue in every sphere of lives. As a result, suicidal tendency and reported cases of suicides stemmed from depression have multiplied. Thus, it appeared essential to bring the community-based mental health services to the community level. In this case, Peer-responding turns out an effective way where target-people have a safe space for expressing their emotions which helps improve the mental health condition.
As the Goal 3 of SDG has also stated to ensure healthy life and promote mental health wellbeing across all ages therefore, mental health issues became a global agenda. It is about time to strengthen community-based mental health for the reduction of mental health issues and to take holistic action in collaboration with government and non-government bodies.