Choose a Color

Nurses for Mental Health: How can we overcome the challenges and build on successes to provide effective mental health care in resource poor settings? 


September 11-26, 2007
http://my.ibpinitiative.org/mentalhealth

The purpose of this two-week forum is to identify problems in mental health care and share information and experiences to come up with innovative solutions to the problems.


Discussion Statistics


Number of participants: 615
Number of participants' countries: 80
Number of contributions: 174
% of contributions from developing countries: 55%
Number of countries contributing: 21 countries

Contributing countries: Australia, Bangladesh, Belgium, Cambodia, Canada, China, Colombia, El Salvador, Ethiopia, Jordan, India, Indonesia, Kenya, Lebanon, Mongolia, the Netherlands, New Zealand, Swaziland, South Africa, US, and the UK


Purpose and Objectives

The purpose of this two-week forum is to identify problems in mental health care and share information and experiences to come up with innovative solutions to the problems.
                                                                                                                                
Week 1 ,  Day 1. Advocating for mental health care and the role of nurses in mental health care

Questions:

  1. How can we advocate for improved mental health care in low and middle income countries?
  2. What are the limitations that make it more difficult for doctors and nurses to provide appropriate mental health care in low and middle income countries?
  3. What has been done and what could be done to improve this?
  4. What roles can nurses play in mental health care, which are at present denied to them?

Summary:

Our first day of discussion was active with 25 contributions from 17 participants on the discussion board. Representatives from the following locations were active in today's discussion: Australia, Bangladesh, Cambodia, Colombia, El Salvador, India, Swaziland, US, and the UK. These represent most but not all of the WHO regions. Topics covered in this day's discussion include – roles of mental health nurses, education and curricula, and barriers to care.
                                                                 
Full text daily digest
Full text daily digest addendum
 
Week 1, Day 2 : 

Questions:

We continued to have an active discussion with 22 contributions from 20 participants on the discussion board. Representatives from the following locations were active in today's discussion: Australia, Belgium, China, Ethiopia, Jordan, Kenya, Lebanon, Mongolia, the Netherlands, New Zealand, the UK, and the US. Guest experts responded to participant contributions and topics included roles of mental health nurses, education and curriculum, and barriers to care.

Full text daily digest

Week 1, Day 3 

Summary:

We continued to have a very active and thought provoking discussion with 21 contributions from the following locations: Australia, Bangladesh, Canada, Ethiopia, Kenya, New Zealand, South Africa, and the US. The consensus of the group is that we need a drastic change to improve mental health care. Jane Mahoney poses the thought-provoking question: "How do we negotiate with others who are not like-minded about this topic to co-construct an improved social view of mental illness? How do we create a “social epidemic” for mental health advocacy?" touches the core of the problem of stigma and mental illness and challenges us to create a “social epidemic” for mental health advocacy. Guest expert Dr. Tesfamicael Ghebrehiwet responds to this and other participant contributions.

Full text daily digest

Week 1, Day 4  

Summary:

Do you consider diaphragms a cost-effective method of family planning? Why or why not? Do you see a role for them in the method mix in the country programs you are aware of? 
What else could be done to achieve renewed interest in diaphragms in countries where providers do not know about diaphragms and few women currently use them? 
What is needed to attract the interest of donor agencies or governments in scaling-up the diaphragm as part of family planning programs?
Last year, results from a large multi site study (called the MIRA study) were released indicating no significant increase in protection against HIV infection when the diaphragm was added to a comprehensive HIV prevention program (i.e. comprehensive counseling and condom provision). Have these results affected your opinion or the opinions of others in your country about role of diaphragms for protecting women’s health?
Work is underway to evaluate diaphragms as a delivery system for a microbicide. Do you think using diaphragms as a microbicide delivery system will help or hinder future introduction and promotion of the diaphragm?
Do you see a stronger role for diaphragms in family planning or HIV prevention programs in the future? Why?

Full text daily digest



                                                                 
Week 1, Day 5 

Summary:

As the first week of discussion has come to an end we are noticing the community is proposing incredibly thought provoking questions. We are also pleased at the increase in contributions which include suggestions and solutions to problems. Today’s digest includes comments on the response to the call of action, rights to prescribing medications, mental health and substance abuse, and personal experiences.

Full text daily digest

Week 2 : Training programs for doctors and nurses in mental health 

Questions:

  1. What are the examples of nurses providing effective mental health care in low resource settings?
  2. Are there innovative training programmes for doctors and nurses to give them the needed knowledge and skills for mental health care?
  3. Should nurses be allowed to prescribe/continue the prescription of psychotropic medicines especially in countries where there are very few doctors and psychiatrists?



                                                                 
Week 2, Day 1 

Summary:

We are thrilled with the response we have received following Dr. Saxena's "Call to Action." We received 16 contributions from the following countries: Australia, Ethiopia, Ghana, Indonesia, Ireland, Jamaica, Nigeria, Panama, South Africa, UK, US, and Zambia. We have received many emails from members noting that our colleagues from low and middle income countries often do not have the means to communicate with us. We are calling on those of you who have worked closely with these more remote communities to be the voice of your colleagues. Share what you have learned from them with us.

Full text daily digest

Week 2, Day 2  

Summary:

Week 2 began with an incredible response from the community. We received 24 contributions from members residing in Australia, Brazil, Ethiopia, Ghana, India, Iran, and US. Participants talked more about prescribing rights and described innovative training programs in several countries. 

Full text daily digest



                                                                 
Week 2, Day 3

Summary:

Contributions on Day 4 came from Australia, Ethiopia, India, the UK and the US. I wish to thank you - today’s contributors - for sharing innovative practices in mental health care. These experiences are valuable and helpful to the 500 members of this Community who are continuously seeking ways of providing better care to patients with mental health problems and their families. The comments from today fall into four categories; effective care in low resource settings, prescribing rights, education, and policy.

Full text daily digest

Week 2, Day 4  

Summary:

We continued to have an active discussion this weekend with 13 contributions from the following countries: Brazil, Canada, India, New Zealand, Panama, South Africa, Tanzania, and Zambia. We received messages about mental health programs in Brazil, Canada, and New Zealand and one participant posted a message about the importance of nurses in research.

Full text daily digest



                                                                 
Week 2, Day 5

Summary:

Our last day of discussion included 8 contributions from Ethiopia, Spain, the US and Zambia. One participant discussed the role of primary health care providers in regards to mental health. Other participants shared success stories and challenges in mental health programs.

Full text daily digest

Program Examples
NIGERIA. Julian Eaton from Nigeria shares the in-country experience of developing community mental health services in Nigeria. I have been working to develop community mental health services in Nigeria for the last 4 years, and have found the Community Psychiatric Nurse to be the central figure in establishing practical services that work. We found that providing some training in mental health to Primary Health Centre (general) nurses did not result in them delivering care to many clients with mental health problems. They were unable to gain adequate skills, and they did not prioritize mental health in their busy schedules. Only by having a dedicated nurse and investing in developing village-based community health workers (volunteers) did we start to really find the people we knew had need in the community. The main issues in keeping the quality of service high has been to provide regular supervision and training, providing transport (motorcycles) for community work, and to run the Drug Revolving Fund (DRF) ourselves (i.e. a Nigerian NGO partner). This may be a uniquely Nigerian factor (where many drugs on the open market are fake and DRFs run in government always collapse).

JAMAICA. Donnahae Rhoden-Salmon from Jamaica shares the background behind the success of Jamaica's mental health programme. Jamaica has had a successful mental health programme despite a lack of resources. This is due mainly to the following factors:
  • The recruitment and training of committed individuals.
  • The implementation of a community based mental health programme.
  • The establishment of a special unit dealing with mental health in the ministry of health.
  • The attempt by the government and other stakeholders to destigmatize mental illness.

Community Mental Health was introduced to Jamaica in the 1960s. Its main focus was prevention. This includes all forms of prevention including primary, secondary and tertiary prevention. One of its components was to train nurses to become mental health officers. These persons would live in the community in which they serve and offer advice and treatment to individuals affected by mental illness. They would also conduct clinics usually under the supervision of a visiting psychiatrist.

To ensure the success of programmes like these and to overcome challenges, a concerted effort must be made by government and other stakeholders to:
  • Recruit committed individuals in these programmes for often they have to work in substandard conditions.
  • Ensure proper remuneration to staff members.
  • Ensure suitable working conditions.
  • Encourage the families to be a part of the care of their family members.
  • Steadfastly follow up all patients that come to the clinic.
  • Maintain an efficient referral system.
  • Initiate and maintain public education about mental illness.
  • Expose members of staff to new forms of treatment including medication if they have limited knowledge.
  • Limit hospital stays for the care of the acute mentally ill to not more than twenty eight days so that persons are not alienated from their family members for a lengthy period of time.
  • Provide some support to family members.
Post-forum survey results

Number of surveys completed 65

% who have passed content to others 44%

% who have or will use in their work  75%

% very satisfied with forum content 72%

Suggestions for improvement :  

  • Discuss further the effects of harmful effects of drug and shock treatment as well as non-medical approaches to behaviors of the mentally ill.
  • Focus on the whole team of primary care professionals providing mental health services rather than solely nurses.
  • The forum needs to continue long term to produce real effective results.
  • Easier access to the discussion resources.
  • Involve consumer groups.
  • Localize topics by region of the participants.
  • Longer duration of forum.
  • More publicity and advertisement
References and resources
Click here for related resources and references in the community library




Organizing groups

World Health Organization, Department of Mental Health and Substance Abuse (WHO/MSD) and International Council of Nurses (ICN).

Contributing experts/facilitators 

Thomas Barrett, Senior Mental Health Consultant, Department of Mental Health and Substance Abuse, WHO

Tesfamicael Ghebrehiwet, Consultant, Nursing & Health Policy, International Council of Nurses

Margaret Grigg, Senior Nurse Advisor Mental Health Branch, Department of Human Services, Melbourne, Australia

Shekhar Saxena, Coordinator Mental Health: Evidence and Research, WHO

Jean Yan, Chief Scientist for Nursing and Midwifery, WHO

Moderators

Christina Fusco RN, MSN, FNP-BC, MPH