Community Mental Health
It is a long distance to go by bus and there’s no money. If he is told to go alone,
he wants me to go with him. We don’t have money for two persons. One has to
earn something to be able to pay!—Care giver from India, 2004
A key issue for building capacity for mental health services in LMIC relates to the lack of available human resources (WHO 2011). Trained professionals are often available only in major cities and they struggle to meet the demand placed on them. Individuals are hesitant to travel to the cities where treatment is available because of the associated transport costs and loss of productive working time. This reduces the extent to which individuals will seek diagnosis, because they have an accurate expectation of the lack of availability of services and the excessive cost of treatment (Saxena et al. 2007).
In BasicNeeds’ experience, the key to improving availability is to provide services geographically closer to the individuals requiring treatment, as also advocated by the WHO (2008). One approach to this is to form a partnership with local health centres and community organisations. These organisations take the lead role in identifying and treating individuals with mental illness. Mental health professionals visit community health posts, clinics, community centres or health centres to provide additional training and support. An alternative is the use of mental health camps (Raja et al. 2012). A team of mental and general health professionals set up temporary facilities for a single day in order to provide treatment. This allows professionals to treat large numbers of people in a relatively short amount of time and to serve the areas most in need. This approach certainly has limitations, as professionals are able to spend very little time with each person. However, camps are backed up by home visits by trained community workers who provide the vital link between the family and the treatment facility (Raja et al. 2014). The community workers in most cases are already attached to primary care facilities treating communicable diseases, maternal and child-care, and so on, and BasicNeeds trains them to also address mental health.
The philosophy of BasicNeeds is to treat all individuals who present at the camps but the organisation appreciates the importance of outreach to identify individuals who could benefit and encourage them to attend. This work is often performed by community workers and volunteers (who are trained by BasicNeeds) and local mental health professionals. Follow-up support is provided primarily through the community workers. This is vital to make sure prescriptions are being followed, particularly where affected individuals are unable to read prescription instructions. However, ongoing supervision is important to ensure that local workers maintain standards, particularly where turnover is high (Raja et al. 2014):
Eunice got to know of the mental health clinic through the community mental health volunteers in the area. ‘George Ratemo comes from this village and knows that I suffer from a mental disorder so he informed us—my mother and I—that a clinic was starting in the neighbourhood in the beginning of May 2006. He even sent someone to keep reminding us of the date.—Extract from the life story of Eunice Wangeci Wambui Kihara, 25 years old female, diagnosed with Panic disorder, Kenya Programme. (BasicNeeds 2007)