Understanding the benefits and challenges of community engagement in the development of community mental health services for common mental disorders: Lessons from a case study in a rural South African subdistrict site

Abstract

Against the backdrop of a large treatment gap for mental disorders in low- to middle-income countries (LMICs), the 2007 Lancet series on global mental health calls for a scaling up of mental health services. Community participation is largely harnessed as one strategy to facilitate this call. Using a participatory implementation framework for the development of mental health services for common mental disorders (CMDs) in a rural subdistrict in South Africa as a case study, this study sought to understand the benefits and challenges of community participation beyond that of scaling up. Qualitative process evaluation involving interviews with service providers and users was employed. The results suggest that in addition to promoting mobilization of resources and actions for scaling up mental health services, community participation can potentially contribute to more culturally competent services and personal empowerment of recipients of care. In addition, community participation holds promise for engendering community-led public health actions to ameliorate some of the social determinants of mental ill health. Challenges include that community members involved in these activities are mainly marginalized women, who have limited power to achieve structural change, including cultural practices that may be harmful to the mental health of women and children. We conclude that in addition to contributing to scaling up mental health services, community participation can potentially promote the development of culturally competent mental health services and greater community control of mental health.

Service user and care giver involvement in mental health system strengthening in Nepal: a qualitative study on barriers and facilitating factors

“…Community participation in decision-making, user empowerment and self-help, and a focus on public needs have been emphasized as characteristics of community based care [56]. With the decentralization of power to communities, the voices of different community groups can be heard and a collective agency can be established to deal with problems [27]. Similarly, integration of mental health into primary health care systems could also ensure some level of representativeness at local level by involving service users in the existing management committees of the primary health care centers.…”

“…Such involvement is considered to be especially important in LMICs where weak national mental health systems are pervasive [27, 28]. The importance of user and caregiver involvement was reinforced by the endorsement and ratification of the UN Convention on the Rights of Persons with Disabilities (UNCRPD), which calls for equal and full participation of persons with disabilities, including those with mental health conditions, in treatments and in the development of mental health laws, policies, and programs [29].…”

Strengthening community mental health competence-A realist informed case study from Dehradun, North India

“…Participants in this study said their own lack of skills and knowledge were a barrier to increasing social inclusion. Increasing community knowledge and skills through formal and informal dialogue, role plays and facilitated support groups is a critical part of reducing stigma and discrimination (Kermode, Bowen, Arole, Pathare, & Jorm, ; Kermode et al., ; Petersen et al., ). According to participants, changes in attitudes were strengthened by modelling of respectful interaction with PPSD by caregivers, project team members and by members of religious institutions such as gurudwara (Papa et al., ).…”

“…We use the term PPSD which is preferentially used by mental health service users (Drew et al., ). Studies set in South Africa describe supporting the development of informal networks among PPSD and self‐help groups as effective strategies to strengthen community mental health and social inclusion underlining the importance of engaging with the social context of PPSD (Burgess, ; Burgess & Campbell, ; Petersen, Ssebunnya, Bhana, & Baillie, ; Petersen et al., ).…”

Mental health service provision in low and middle-income countries

“…Mental healthcare provided by CHWs requires competences from nurses, clinical officers or lay persons in, for example, case identification and some medication prescribing authority [31][32][33]. Although there are some promising examples, no clear picture emerges of which indications and which interventions are adequately served by CHWs with only basic mental health training.…”