Service user involvement in mental health system strengthening in a rural African setting: qualitative study
Abstract Background It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore bar...
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| Format: | Article |
| Language: | English |
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BMC
2017-05-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12888-017-1352-9 |
| _version_ | 1828454316653936640 |
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| author | Sisay Abayneh Heidi Lempp Atalay Alem Daniel Alemayehu Tigist Eshetu Crick Lund Maya Semrau Graham Thornicroft Charlotte Hanlon |
| author_facet | Sisay Abayneh Heidi Lempp Atalay Alem Daniel Alemayehu Tigist Eshetu Crick Lund Maya Semrau Graham Thornicroft Charlotte Hanlon |
| author_sort | Sisay Abayneh |
| collection | DOAJ |
| description | Abstract Background It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. Methods Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. Results All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. Conclusion As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated. |
| first_indexed | 2024-12-11T00:19:56Z |
| format | Article |
| id | doaj.art-aaa688b5cd1f41d39555c8acee22df0e |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-11T00:19:56Z |
| publishDate | 2017-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-aaa688b5cd1f41d39555c8acee22df0e2022-12-22T01:27:48ZengBMCBMC Psychiatry1471-244X2017-05-0117111410.1186/s12888-017-1352-9Service user involvement in mental health system strengthening in a rural African setting: qualitative studySisay Abayneh0Heidi Lempp1Atalay Alem2Daniel Alemayehu3Tigist Eshetu4Crick Lund5Maya Semrau6Graham Thornicroft7Charlotte Hanlon8Department of Psychiatry, University College of Health Sciences, School of MedicineKing’s College London, Academic Rheumatology, Weston Education Centre, 10Department of Psychiatry, University College of Health Sciences, School of MedicineDepartment of Psychiatry, University College of Health Sciences, School of MedicineDepartment of Psychiatry, University College of Health Sciences, School of MedicineDepartment of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape TownHealth Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and NeuroscienceHealth Service and Population Research Department, King’s College London, Institute of Psychiatry, Psychology and NeuroscienceDepartment of Psychiatry, University College of Health Sciences, School of MedicineAbstract Background It is essential to involve service users in efforts to expand access to mental health care in integrated primary care settings in low- and middle-income countries (LMICs). However, there is little evidence from LMICs to guide this process. The aim of this study was to explore barriers to, and facilitators of, service user/caregiver involvement in rural Ethiopia to inform the development of a scalable approach. Methods Thirty nine semi-structured interviews were carried out with purposively selected mental health service users (n = 13), caregivers (n = 10), heads of primary care facilities (n = 8) and policy makers/planners/service developers (n = 8). The interviews were audio-recorded and transcribed in Amharic, and translated into English. Thematic analysis was applied. Results All groups of participants supported service user and caregiver involvement in mental health system strengthening. Potential benefits were identified as (i) improved appropriateness and quality of services, and (ii) greater protection against mistreatment and promotion of respect for service users. However, hardly any respondents had prior experience of service user involvement. Stigma was considered to be a pervasive barrier, operating within the health system, the local community and individuals. Competing priorities of service users included the need to obtain adequate individual care and to work for survival. Low recognition of the potential contribution of service users seemed linked to limited empowerment and mobilization of service users. Potential health system facilitators included a culture of community oversight of primary care services. All groups of respondents identified a need for awareness-raising and training to equip service users, caregivers, service providers and local community for involvement. Empowerment at the level of individual service users (information about mental health conditions, care and rights) and the group level (for advocacy and representation) were considered essential, alongside improved, accessible mental health care and livelihood interventions. Conclusion As Ethiopia increases access to mental health care, a fundamental barrier to service user involvement is beginning to be addressed. Our study identified further barriers that need to be tackled, including a supportive political climate, and receptiveness amongst stakeholders. The findings will inform the development of a model of service user involvement, which will be piloted and evaluated.http://link.springer.com/article/10.1186/s12888-017-1352-9Qualitative studyMental healthEthiopiaService user and carer involvement |
| spellingShingle | Sisay Abayneh Heidi Lempp Atalay Alem Daniel Alemayehu Tigist Eshetu Crick Lund Maya Semrau Graham Thornicroft Charlotte Hanlon Service user involvement in mental health system strengthening in a rural African setting: qualitative study BMC Psychiatry Qualitative study Mental health Ethiopia Service user and carer involvement |
| title | Service user involvement in mental health system strengthening in a rural African setting: qualitative study |
| title_full | Service user involvement in mental health system strengthening in a rural African setting: qualitative study |
| title_fullStr | Service user involvement in mental health system strengthening in a rural African setting: qualitative study |
| title_full_unstemmed | Service user involvement in mental health system strengthening in a rural African setting: qualitative study |
| title_short | Service user involvement in mental health system strengthening in a rural African setting: qualitative study |
| title_sort | service user involvement in mental health system strengthening in a rural african setting qualitative study |
| topic | Qualitative study Mental health Ethiopia Service user and carer involvement |
| url | http://link.springer.com/article/10.1186/s12888-017-1352-9 |
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