Creating Evidence-Based Youth Mental Health Policy in Sub-Saharan Africa: A Description of the Integrated Approach to Addressing the Issue of Youth Depression in Malawi and Tanzania

This chapter stems from ongoing field research on mental health in Senegal, an African country in the midst of an epidemiological transition. While mental health has been integrated into global health and sustainable development objectives, it is not a priority in sub-Saharan Africa. Few states have a mental health policy, nor specific programmes and data on the situation of mentally ill people and their families. From the time of the French colonization, Senegal has developed an original strand of psychiatric intervention, the Fann School of Cultural Psychiatry. The current supply of psychiatric care takes place in the multi-therapeutic context of this ethnically and religiously diverse society. The therapeutic pathways of patients are analysed in terms of stigmatization, relationships between patients and healers, socio-economic inequalities, poverty, and the absence of universal medical coverage for the entire population. To understand adherence to psychiatric treatment, one must take into account the family and social dynamics at work in a society increasingly marked by individuation processes and globalization through international migration. In attending to the subtleties of care as conceived by sufferers’ families and social networks, the chapter points to multiple layers of the demographic governance of mental ill health, from the state to local kin and social groups.

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Mental health in Sierra Leone

BJPsych International ◽

10.1192/bji.2019.17 ◽

2019 ◽

Vol 17 (1) ◽

pp. 14-16 ◽

Cited By ~ 1

Author(s):

Dawn Harris ◽

Tarik Endale ◽

Unn Hege Lind ◽

Stephen Sevalie ◽

Abdulai Jawo Bah ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Sierra Leone ◽

Quality Care ◽

Mental Health Policy ◽

Sub Saharan Africa ◽

National Budget ◽

People With Mental Illness ◽

Provide Quality Care ◽

Sub Saharan

Sierra Leone is a West African country with a population of just over 7 million. Many Sierra Leoneans lived through the psychologically distressing events of the civil war (1991–2002), the 2014 Ebola outbreak and frequent floods. Traditionally, mental health services have been delivered at the oldest mental health hospital in sub-Saharan Africa, with no services available anywhere else in the country. Mental illness remains highly stigmatised. Recent advances include revision of the Mental Health Policy and Strategic Plan and the strengthening of mental health governance and district services. Many challenges lie ahead, with the crucial next steps including securing a national budget line for mental health, reviewing mental health legislation, systematising training of mental health specialists and prioritising the procurement of psychotropic medications. National and international commitment must be made to reduce the treatment gap and provide quality care for people with mental illness in Sierra Leone.

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Evidence-based mental health policy: Acritical appraisal

The British Journal of Psychiatry ◽

10.1192/bjp.183.2.105 ◽

2003 ◽

Vol 183 (2) ◽

pp. 105-113 ◽

Cited By ~ 33

Author(s):

Brian Cooper

Keyword(s):

Mental Health ◽

Health Care ◽

Health Policy ◽

Health Planning ◽

Mental Health Policy ◽

Evidence Base ◽

Service Evaluation ◽

Current Evidence ◽

Evidence Based ◽

Evidence Based Health Care

BackgroundArguments for and against evidence-based psychiatry have mostly centred on its value for clinical practice and teaching. Now, however, use of the same paradigm in evaluating health care has generated new problems.AimsTo outline the development of evidence-based health care; to summarise the main critiques of this approach; to review the evidence now beingemployed to evaluate mental health care; and to consider how the evidence base might be improved.MethodThe following sources were monitored: pub ications on evidence-based psychiatry and health care since 1990; reports of randomised trials and meta-analytic reviews to the end of 2002; and official British publications on mental health policy.ResultsAlthough evidence-based health care is now being promulgated as a rational basis for mental health planning in Britain, its contributions to service evaluation have been distinctly modest. Only 10% of clinical trials and meta-analyses have been focused on effectiveness of services, and many reviews proved inconclusive.ConclusionsThe current evidence-based approach is overly reliant on meta-analytic reviews, and is more applicable to specific treatments than to the care agencies that control theirdelivery. A much broader evidence base is called for, extending to studies in primary health care and the evaluation of preventive techniques.

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Policymaking through a knowledge lens: Using the embodied-enacted-inscribed knowledge framework to illuminate the transfer of knowledge in a mental health policy consultation process – A South African case study

PLoS ONE ◽

10.1371/journal.pone.0244940 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244940

Author(s):

Debra Leigh Marais ◽

Inge Petersen ◽

Michael Quayle

Keyword(s):

Mental Health ◽

Health Policy ◽

Mental Health Policy ◽

Experiential Knowledge ◽

Evidence Based ◽

Transfer Of Knowledge ◽

Consultation Process ◽

Knowledge Framework ◽

What Works ◽

Use Of Knowledge

Background Marrying principles of evidence-based policymaking, with its focus on what works, with principles of consultative policymaking, with its focus on what works for whom, means finding ways to integrate multiple knowledge inputs into policy decisions. Viewed through the lens of the embodied-enacted-inscribed knowledge framework, policy consultation is a site of knowledge enactment, where the embodied knowledge enacted by individuals engages with the inscribed knowledge contained in policy documents, creating new forms of embodied and inscribed knowledge that move beyond these spaces. Aim Using this knowledge framework, this study aimed to trace the movement of knowledge inputs through South Africa’s mental health policy consultation summit. Methods Breakaway group session transcripts from the national consultation summit were thematically analysed to identify the types of knowledge that participants explicitly drew on (experiential or evidence-based) during discussions and how these knowledge inputs were used, responded to, and captured. Findings Findings suggest that there was little explicit reference to either evidence-based or experiential knowledge in most of the talk. While slightly more evidence-based than experiential knowledge claims were made, this did not render these claims any more likely to be responded to or engaged with in group discussions, or to be inscribed in group recommendations. Discussion The importance of designing participatory processes that enable optimal use of knowledge inputs in these enacted spaces is discussed. Conclusion Attending to the specific ways in which knowledge is transformed and moved through a policy consultation process has the potential to enhance the value that consultation offers policymakers.

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The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building: a program protocol for building implementation science and mental health research and policymaking capacity in Malawi and Tanzania

International Journal of Mental Health Systems ◽

10.1186/s13033-019-0327-2 ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Christopher Fittipaldi Akiba ◽

Vivian Go ◽

Victor Mwapasa ◽

Mina Hosseinipour ◽

Bradley Neil Gaynes ◽

...

Keyword(s):

Mental Health ◽

Capacity Building ◽

Scale Up ◽

Sub Saharan Africa ◽

Evidence Based ◽

Regional Partnership ◽

Sub Saharan ◽

Building Program ◽

Capacity Building Program ◽

Research And Policy

Abstract Background Mental health (MH) disorders in low and middle-income countries (LMICs) account for a large proportion of disease burden. While efficacious treatments exist, only 10% of those in need are able to access care. This treatment gap is fueled by structural determinants including inadequate resource allocation and prioritization, both rooted in a lack of research and policy capacity. The goal of the Sub-Saharan Africa Regional Partnership for Mental Health Capacity Building (SHARP), based in Malawi and Tanzania, is to address those research and policy-based determinants. Methods SHARP aims to (1) build implementation science skills and expertise among Malawian and Tanzanian researchers in the area of mental health; (2) ensure that Malawian and Tanzanian policymakers and providers have the knowledge and skills to effectively apply research findings on evidence-based mental health programs to routine practice; and (3) strengthen dialogue between researchers, policymakers, and providers leading to efficient and sustainable scale-up of mental health services in Malawi and Tanzania. SHARP comprises five capacity building components: introductory and advanced short courses, a multifaceted dialogue, on-the-job training, pilot grants, and “mentor the mentors” courses. Discussion Program evaluation includes measuring dose delivered and received, participant knowledge and satisfaction, as well as academic output (e.g., conference posters or presentations, manuscript submissions, grant applications). The SHARP Capacity Building Program aims to make a meaningful contribution in pursuit of a model of capacity building that could be replicated in other LMICs. If impactful, the SHARP Capacity Building Program could increase the knowledge, skills, and mentorship capabilities of researchers, policymakers, and providers regarding effective scale up of evidence-based MH treatment.

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Mental health research capacity building in sub-Saharan Africa: the African Mental Health Research Initiative

Global Mental Health ◽

10.1017/gmh.2019.32 ◽

2020 ◽

Vol 7 ◽

Author(s):

Dixon Chibanda ◽

Melanie Abas ◽

Rosemary Musesengwa ◽

Chris Merritt ◽

Katherine Sorsdahl ◽

...

Keyword(s):

Mental Health ◽

Low Income ◽

Health Research ◽

Research Capacity ◽

Mental Health Research ◽

Sub Saharan Africa ◽

Theory Of Change ◽

Evidence Based ◽

Research Initiative ◽

Sub Saharan

Abstract Mental, neurological and substance use (MNS) disorders are a leading, but neglected, cause of morbidity and mortality in sub-Saharan Africa. The treatment gap for MNS is vast with only 10% of people with MNS disorders in low-income countries accessing evidence-based treatments. Reasons for this include low awareness of the burden of MNS disorders and limited evidence to support development, adaptation and implementation of effective and feasible treatments. The overall goal of the African Mental Health Research Initiative (AMARI) is to build an African-led network of MNS researchers in Ethiopia, Malawi, South Africa and Zimbabwe, who are equipped to lead high quality mental health research programs that meet the needs of their countries, and to establish a sustainable career pipeline for these researchers with an emphasis on integrating MNS research into existing programs such as HIV/AIDS. This paper describes the process leading to the development of AMARI's objectives through a theory of change workshop, successes and challenges that have been faced by the consortium in the last 4 years, and the future role that AMARI could play in further building MNS research capacity by brining on board more institutions from low- and middle-income countries with an emphasis on developing an evidence-based training curriculum and a research-driven care service.

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Evidence-based mental health policy

Practical Psychiatric Epidemiology ◽

10.1093/med/9780198735564.003.0024 ◽

2020 ◽

pp. 405-424

Author(s):

Valentina Iemmi ◽

Nicole Votruba ◽

Graham Thornicroft

Keyword(s):

Mental Health ◽

Health Policy ◽

Research Evidence ◽

Mental Health Policy ◽

Historical Context ◽

Healthcare Facility ◽

Evidence Based ◽

Policy Cycle ◽

Facility Level ◽

Use Of Research

This chapter describes evidence-based mental health policy with the help of illustrative examples. After briefly setting the use of research evidence to inform mental health policy within the broader historical context, the second section of the chapter provides a brief description of evidence-based mental health policy and its rationale. The third section illustrates how mental health research may help inform mental health policy, with a description of the research cycle, the policy cycle, their relationship, and the use of epidemiological studies for policymaking. The fourth section provides examples of the use of research evidence in mental health policy at different organizational levels, from the clinical level (micro-level), through the service provision/healthcare facility level (meso-level) and the whole health system level (macro-level), to the global level (mega-level). Finally, the chapter concludes by reflecting on some of the opportunities and challenges that influence evidence-based mental health policy.

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