Policy perspectives and attitudes towards mental health treatment in rural Senegal

International Journal of Mental Health Systems

Idrissa Ba³  Demetri Blanas¹  Youssoupha Ndiaye²  Nicole M Monteiro⁴ 

[1] Institute For Family Health/Icahn School of Medicine at Mount Sinai, New York, USA;Ministry of Health and Social Action, Dakar, Senegal;Faculté de Médecine, Pharmacie et Odontostomatologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal;Department of Psychology, University of Botswana, Private Bag, Gaborone 00775, Botswana

关键词: Traditional healing;    Primary care system;    Mental health;    Senegal;    Sub-Saharan Africa;   

Others  :  801177
DOI  :  10.1186/1752-4458-8-9

 received in 2013-11-27, accepted in 2014-03-16,  发布年份 2014

【 摘 要 】

Background

Mental health is often given low priority in health policy planning, particularly in developing countries. Several international health bodies, including the World Health Organization, recommend integrating mental health into primary care settings to reduce mortality and morbidity associated with mental illness, particularly in low-resource settings.

Objective

This study explores health care workers' and policy stakeholders’ knowledge and attitudes regarding mental illness, interactions with patients in the community, and perceived training needs at a health clinic in rural southeastern Senegal. Interviews were conducted with eight key informant medical staff members and community health workers.

Methods

Interview data were analyzed and interpreted using a qualitative content analysis based on the grounded theory approach.

Results

The findings indicate that staff members encounter many patients with emotional/psychological problems or mental illnesses, and they employ various strategies in treating these patients. Respondents also highlighted the need for more training to address and diagnose mental health problems, especially severe psychiatric illnesses.

Conclusions

Findings are used to discuss recommendations for developing a comprehensive mental health primary care treatment approach that includes screening patients for mental health problems screening, incorporating rural villagers' attitudes and beliefs about mental illness into treatment, and utilizing community health workers—who are often a first health contact for many—to work with the medical staff to identify mental health problems.

【 授权许可】

   
2014 Monteiro et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Chisholm D, Flisher AJ, Lund C, Patel V, Saxena S, Thornicroft G, Tomlinson M: Scale up services for mental disorders: a call for action. Lancet 2007, 370(9594):1241-1252.
• [2]Patel V, Boyce N, Collins PY, Saxena S, Horton R: A renewed agenda for global mental health. Lancet 2011, 378(9801):1441-1442.
• [3]Lancet Global Mental Health Working Group: Executive summary. The Lancet 2007370. http://www.thelancet.com/series/global-mental-health webcite
• [4]Movement for global mental health http://www.globalmentalhealth.org/about webcite
• [5]World Organization of National Colleges, Academies, & Academic Associations of General Practitioners-Family Physicians: Integrating Mental Health into Primary Health Care: A Global Perspective. Geneva: World Health Organization; 2008.
• [6]Jacob KS, Sharan P, Mirza I, Garrido-Cumbrera M, Seedat S, Mari JJ, Saxena S: Mental health systems in countries: where are we now? Lancet 2007, 370(9592):1061-1077.
• [7]Desjarlais R, Eisenberg L, Good B, Kleinman A: World Mental Health: Problems and Priorities in Low-Income Countries. New York: Oxford University Press; 1995.
• [8]World Health Organization, Mental Health Research and Evidence, Department of Mental Health and Substance Dependence: Prevention and Promotion in Mental Health. Geneva: World Health Organization; 2002.
• [9]Patel V, Araya R, Chatterjee S, Chisholm D, Cohen A, De Silva M, Van Ommeren M: Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 2007, 370(9591):991-1005.
• [10]World Health Organization, Department of Mental Health & Substance Abuse: Mental Health Atlas: 2011- Senegal. Geneva: World Health Organization; 2011.
• [11]Mathers CD, Fat DM, Boerma JT: The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.
• [12]World Health Organization, Department of Mental Health & Substance Abuse: Mental Health Atlas: 2005. Geneva: World Health Organization; 2005.
• [13]World Health Organization, Regional Office for Africa: Senegal - Factsheets of Health Statistics. Geneva: World Health Organization; 2010.
• [14]Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, Rahman A: No health without mental health. Lancet 2007, 370(9590):859-877.
• [15]Saxena S, Thornicroft G, Knapp M, Whiteford H: Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007, 370(9590):878-889.
• [16]Gary FA: Stigma: barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing 2005, 26(10):979-999.
• [17]Sartorius N: Stigma and mental health. Lancet 2007, 370(9590):810-811.
• [18]Central intelligence agency, the world fact book – Senega https://www.cia.gov/library/publications/the-world-factbook/geos/bc.html webcite
• [19]Balde S, Clark S: Traditional healers in Casamance, Senegal. World Health Forum 1994, 15:390-392.
• [20]Diop B, Collignon R, Guèye M, Harding TW: Diagnosis and symptoms of mental disorder in a rural area of Senegal. Afr J Med Med Sci 1982, 11(3):95-103.
• [21]Ignacio LL, De Arango MV, Baltazar J, Busnello ED, Climent CE, Elhakim A, Wig NN: Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries. Am J Public Health 1983, 73(9):1081-1084.
• [22]Thiam MH, Gueye M: Clinical aspects of hysteria at the psychiatric clinic of the Fann University Hospital Center. Apropos of a prospective study of 121 cases. Dakar Med 1998, 43(1)):41-44.
• [23]Beiser M, Ravel JL, Collomb H, Egelhoff C: Assessing psychiatric disorder among the Serer of Senegal. J Nerv Ment Dis 1972, 154(2):141-151.
• [24]Morón-Nozaleda MG, de Tojeiro JG, Cobos-Muñoz D, Fernández-Liria A: Integrating mental health into primary care in Africa: the case of equatorial guinea. Intervention 2011, 9(3):304-314.
• [25]Bhana A, Petersen I, Baillie KL, Flisher AJ: Implementing the world health report 2001 recommendations for integrating mental health into primary health care: a situation analysis of three African countries: Ghana, South Africa and Uganda. International Review of Psychiatry 2010, 22(6):599-610.
• [26]Kapungwe A, Cooper S, Mayeya J, Mwanza J, Mwape L, Sikwese A, Lund C: Attitudes of primary health care providers towards people with mental illness: evidence from two districts in Zambia. African Journal of Psychiatry 2011, 14(4):290-297.
• [27]Jenkins R, Kiima D, Njenga F, Okonji M, Kingora J, Kathuku D, Lock S: Integration of mental health into primary care in Kenya. World Psychiatry 2010, 9(2):118-120.
• [28]Guest G, Bunce A, Johnson L: How many interviews are enough? An experiment with data saturation and variability. Field Methods 2006, 18(1):59-82.
• [29]Nastasi B: Study notes: qualitative research: sampling & sample size considerations. https://my.laureate.net/Faculty/docs/Faculty%20Documents/qualit_res__smpl_size_consid.doc webcite
• [30]Bradley EH, Curry LA, Devers KJ: Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res 2007, 42(4):1758-1772.
• [31]Glaser BG, Strauss AL: The Discovery of Grounded Research: Strategies for Qualitative Research. New York: Aldine De Gruyter; 1967.
• [32]Gureje O, Alem A: Mental health policy development in Africa. Bull World Health Organ 2000, 78(4):475-482.
• [33]Alem A, Jacobsson L, Hanlon C: Community‒based mental health care in Africa: mental health workers’ views. World Psychiatry 2008, 7(1):54-57.
• [34]Ali BS, Rahbar MH, Naeem S, Gul A, Mubein S, Iqbal A: The effectiveness of counseling on anxiety and depression by minimally trained counselors: a randomized controlled trial. Am J Psychother 2003, 57(3):324-336.