Mental illness in Bwindi, Uganda: Understanding stakeholder perceptions of benefits and barriers to developing a community-based mental health programme

• Published in: African journal of primary health care & family medicine Vol. 9; no. 1; pp. e1 - e7
• Main Authors: Sessions, Kristen L, Wheeler, Lydia, Shah, Arya, Farrell, Deenah, Agaba, Edwin, Kuule, Yusufu, Merry, Stephen P
• Format: Journal Article
• Language: English
• Published: South Africa African Online Scientific Information Systems (Pty) Ltd t/a AOSIS 2017; AOSIS (Pty) Ltd; AOSIS; AOSIS Publishing
• Subjects: Biology; Care and treatment; Community health care; community mental health; Community Mental Health Services - methods; Community Mental Health Services - statistics & numerical data; Female; Health aspects; Health care access; Health care policy; Health Care Sciences & Services; Health services; Health Services Accessibility - statistics & numerical data; Hospitals; Humans; Male; Management; Medical personnel; Medicine, General & Internal; Mental disorders; Mental Disorders - therapy; mental health; Mental health care; Mental health services; Nurses; Original Research; Perceptions; Planning; Population; Practice; Primary care; Psychiatry; Psychology; Qualitative research; Risk factors; Rural areas; Social aspects; Stakeholder Participation; Stigma; Uganda; Wellness programs; Workers; Uganda; South Africa; Nigeria; Nepal; Ethiopia; India
• ISSN: 2071-2928; 2071-2936; 2071-2936
• DOI: 10.4102/phcfm.v9i1.1462

Mental illness has been increasingly recognised as a source of morbidity in low- and middle-income countries and significant treatment gaps exist worldwide. Studies have demonstrated the effectiveness of task sharing through community-based treatment models for addressing international mental health issues. This paper aims to evaluate the perceptions of a wide range of mental health stakeholders in a Ugandan community regarding the benefits and barriers to developing a community-based mental health programme. Bwindi Community Hospital (BCH) in south-west Uganda provides services through a team of community health workers to people in the Kanungu District. Thematic analysis of 13 semi-structured interviews and 6 focus group discussions involving 54 community members and 13 mental health stakeholders within the BCH catchment area. Stakeholders perceived benefits to a community-based compared to a hospital-based programme, including improved patient care, lower costs to patients and improved community understanding of mental illness. They also cited barriers including cost, insufficient workforce and a lack of community readiness. Stakeholders express interest in developing community-based mental health programmes, as they feel that it will address mental health needs in the community and improve community awareness of mental illness. However, they also report that cost is a significant barrier to programme development that will have to be addressed prior to being able to successfully establish such programming. Additionally, many community members expressed unique sociocultural beliefs regarding the nature of mental illness and those suffering from a psychiatric disease.