Interventions to increase use of services; Mental Health Awareness in Nigeria

Abstract

BackgroundMental health services in Nigeria consist mainly of large government psychiatric hospitals and there are very few mental health professionals to serve the large population of the country. However, more recently, community mental health services, which have been shown to improve access to care and clinical outcomes are beginning to develop in some locations. Despite efforts to promote more accessible services, low levels of knowledge about effective treatment of mental disorders means that even where these services are available, a very small proportion of people utilise these services. Therefore interventions to increase service use are an essential component of health system.MethodsThis intervention was designed to increase use of a mental health services through the work of community-based Village Health Workers. Fifteen Village Health Workers in each Local Government Area (district) were selected and trained to create mental health awareness in communities. Their function also include identification and referral of persons with mental illness to trained mental health nurses in the clinics. Attendance data prior to and after intervention were collected and compared.ResultsThe incident rate for initial period of intervention is five times higher than the baseline rate (95% CI; 3.42–7.56; p < 0.001) though this diminished in the long term, levelling off above initial baseline.ConclusionsThis study demonstrated that addition of awareness raising using volunteers in communities as part of health programme implementation can increase services use by a population. Mechanisms such as informing populations of the existence of a service which they were previously lacking; explanation of causation of mental illness and achieving community leaders’ support for a new service can make investment in services more efficient by increasing attendance.

Community Involvement in the Care of Persons Affected by Podoconiosis—A Lesson for Other Skin NTDs

“…The few studies published from low- and middle-income countries (LMICs) that have aimed to increase uptake of mental-health services by reducing stigma in the local community have included awareness-raising to change community knowledge and attitudes towards people with mental illness as their core component [ 35 , 36 , 37 ]. A program implemented in several states in Nigeria [ 35 , 36 ], for example, led to a significant increase in the use of community-based primary-care mental-health services by training voluntary lay community health workers (CHWs) to deliver positive health messages and challenge misconceptions around mental health, alongside a media campaign of radio announcements, jingles, and newspaper coverage. The program highlighted the importance of regular ‘booster’ training (e.g., every six months) and supervision, plus possibly other initiatives (such as incentives or paid work), to sustain CHWs’ enthusiasm and the effectiveness of the program over time.…”

Partnership for the implementation of mental health policy in Nigeria: a case study of the Comprehensive Community Mental Health Programme in Benue State

“…In addition to national and state-level advocacy, CCMHP supports community-level awareness raising, which has been shown to increase uptake of mental health services in other parts of Nigeria [45,46]. Mental health advocates are selected by the CPN and Primary Health Care Coordinator of the local government area, on the basis of the individual's interest in mental health, residence in the local government area, willingness to undertake advocacy work on a volunteer basis, and ability to read and write in at least one local language.…”

“…Mental health advocates are selected by the CPN and Primary Health Care Coordinator of the local government area, on the basis of the individual's interest in mental health, residence in the local government area, willingness to undertake advocacy work on a volunteer basis, and ability to read and write in at least one local language. During CCMHP's first phase, 72 mental health advocates [46], a training of trainers was held for 21 trainers from local government, Benue State University Teaching Hospital, two local NGOs, and CPNs providing services through CCMHP. Mental health advocates were then trained by these trainers over a four-day period.…”

Barriers and Drivers to Service Delivery in Global Mental Health Projects

“…System-strengthening and integrating promotional efforts within existing resources in the setting (e.g. recruiting lay health workers who already worked within the same communities) increased the long-term likelihood for sustaining mental health services and creating more supportive networks for service users in their communities (16).…”