Peer-delivered mental health interventions – a pragmatic solution to scaling-up access to mental healthcare?

By Dr Kike Olajide, Wellcome Global Health Clinical Research Fellow, Centre for Psychiatry, Imperial College London.

MHAW17 BadgeGlobally, the number of people with depression and anxiety is on the rise – up from 416 million in 1990 to 615 million in 2013. The World Health Organisation estimates that mental illness is now the leading cause of disability worldwide, accounting for over 15% of years lost due to disability (YLD). In addition to disability, common mental illnesses such as depression can lead to suicide. If you are aged 15 to 29 and living in Europe, the thing most likely to kill you, is you – suicide is the leading cause of death in this age group.

Top 10 RankingsAside from the significant morbidity and mortality associated with mental illness for the individual, there are far-reaching consequences for society. Maternal mental illness is associated with a wide range of adverse outcomes in offspring, including behavioural difficulties and compromised physical and cognitive development. Childhood mental illness is the biggest predictor of mental illness in adult life, with an estimated three quarters of mental illness beginning in childhood. The economic impact of mental illness is vast – not just the direct cost of care, but also the loss of income due to early and often chronic unemployment.

Today marks the beginning of Mental Health Awareness Week. The past decade has seen mental health brought out of the shadows and placed firmly in the spotlight. 2015 marked the inclusion of mental health in the Sustainable Development Goals, while it had been previously overlooked in the Millennium Development Goals. An increased awareness of mental health issues has resulted in a concerted effort to scale-up mental health services in resource-poor countries and a number of innovative, cost-effective strategies such as ‘task-sharing’ have emerged.

‘Task sharing’ is the training of non-specialist health providers in the management of mental disorders; it is perhaps the most pragmatic solution to global inequalities in mental health care access. Non-specialist workers tend to be cheaper and more readily available; they facilitate the movement of psychiatric services from tertiary specialist centres into primary health care facilities, thereby increasing access to mental health services.

We are currently collaborating with researchers at the University of Ibadan to develop a peer-delivered psychosocial intervention for the treatment of perinatal depression in Nigerian mothers. Nigeria suffers from a severe shortage of mental health professionals, which contributes to a treatment gap in mental health care: there are an estimated 0.06 psychiatrists per 100,000 of the population and 90% of mental illness goes untreated. As part of our project, we are conducting a qualitative study exploring the suitability of Community Birth Attendants to deliver a psychological intervention, and potential barriers and facilitators to mothers receiving treatment. Community Birth Attendants are women who generally have no formal medical qualifications, they assist mothers at delivery and live in the communities they serve. In our study we found the perceived characteristics of Community Birth Attendants mapped neatly onto the desired characteristics of the ideal mental health care-giver. Community Birth Attendants were viewed as approachable and trustworthy; their ability to offer flexibility in terms of payment for services, and their shared experience of birth and motherhood were viewed as key to facilitators to mothers seeking help.

Globally, only 1 in 3 people living with mental illness receives treatment. It is sometimes easy to forget that behind the statistics are people – people with potential and promise, and a yearning for their political and constitutional rights to be matched by mental health rights. As a mental health researcher and clinician, I believe that we all have a responsibility to help transform passive witnessing of global mental health inequalities into compassionate, evidence-based action.

Hear more from Dr Kike Olajide at the upcoming Centre for International Child Health seminar titled, ‘Adolescent Mental Health – Depression from Acton to Africa’. Register here.

Follow Dr Kike Olajide on Twitter here.

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