In new research, MQ Fellow Dr Ethel Nakimuli-Mpungu has successfully trialled an innovative way to increase access to effective mental health care in Sub-Saharan Africa.
Working in Northern Uganda, she trained lay health workers to provide treatment for depression in HIV patients, integrating cost-effective psychological therapy into their existing care. The trial, published in The Lancet Global Health, not only proved effective in improving the patient’s depression, but also showed benefits to HIV treatment uptake and wider mental health outcomes.
This cost-effective and scalable approach offers real potential for expanding the reach of mental health care - and tackling major public health challenges – across the African continent where resources are severely limited.
In post-conflict Northern Uganda, people living with HIV experience rates of depression, addiction, and post-traumatic stress that are far higher than the general population. Health care workers travel to remote communities across the region to educate patients about HIV, however access to psychological therapies remains scarce. Leaving these mental health problems untreated can have severe public health consequences.
Ethel and her team worked to test a new way to take on this major challenge. In 30 primary health centres across three districts in rural Northern Uganda, they assessed the effectiveness of training lay health workers to deliver a psychological intervention called Group Support Psychotherapy (GSP) to treat depression in HIV patients.
GSP is a culturally sensitive cognitive behavioural based intervention that treats depression by enhancing emotional and social support, positive coping, and livelihood skills. Patients are able to discuss their personal experience of HIV in a group setting and are offered guidance and support. The intervention addresses not only the emotional symptoms of depression but major risk factors such as stigma and discrimination.
GSP also address the enormous socio-economic disadvantages that HIV patients face. Most patients have lower levels of education and live in poverty with no means of generating income. These factors precipitate and perpetuate their mental health problems.
The research found GSP to have a significant effect on patients' depression. Almost all of those who received the intervention achieved remission 6 months after treatment and remained depression-free 12 months later. Participants were also more likely to stick to their HIV medication and displayed substantially lower rates of post-traumatic-stress, suicide risk, and alcohol misuse.
The intervention also proved to be more cost-effective than the present HIV-education program used in these communities, and according to the standards set by the World Health Organisation, is well within the acceptable cost range for an intervention. One of the main factors that contributed to this was the use of lay health workers, who work predominantly on a voluntary basis.
Accessing effective mental health treatment is a huge problem in many isolated places. This research indicates that it is possible to overcome barriers of poverty, remoteness, mental health stigma, and cultural ignorance to deliver an effective and affordable mental health intervention to those who desperately need it.
The project has already received further funding from the US National Institute for Health (NIH) and Child Relief International Foundation to test the intervention across more countries and age groups.
This is generating real excitement that the intervention could be scaled up to reduce rates of mental health problems across the African continent, as well as tackling the spread of major public health challenges like HIV.
Last updated: 13 March 2020