Table 2 Three models of community mental health services in low-resource settings

Abuja, Federal Capital Territory, Nigeria

Tabaco City, Albay Province, Philippines

Dr Somerville Memorial CSI Medical College & Hospital, Karakonam, Kerala India

Community catchment areas: Pozhiyoor, Thiruvananthapuram, Kerala Thuthoor & Colachel, Kanyakumari,Tamil Nadu

8,000 sq km [29]

Albay Province: 2,553 sq km

Kerala: 25 sq km*

Bicol Region: 18,130 sq km [30]

Kanyakumari: 60 sq km

1.4 million[29]

Albay Province: 1.3 million Bicol Region: 5.7 million [30]

100,000

Low-income, but within a region of great economic inequalities

Low-income

Mostly low-income

.511 (Nigeria) [31]

.577 (Albay Province) [32]

.763 (Kanyakumari, TN) [34]

.775 (Kerala) [33]

ORGANIZATION

Mental health services comprise one component of a multi-faceted CBR program

Residential facility and outpatient clinic; on-going collaborations with 2 CBR programs and local governments

Inpatient and outpatient clinics at a general hospital; community-based activities and clinics; collaboration with CBR program

• Archdiocese of Abuja

• CBM

• Internally generated revenue from drug receipts

• Brothers of Charity

• CBM

• Municipalities of Tiwi and Tabaco City subsidize client expenses and provide transportation to outpatient clinic.

• CBM

• Dr Somerville Memorial CSI Medical College & Hospital^†

Director

Administrative Assistant

Director

2 Administrative staff

Director Project

Officer

1 Program Coordinator

Full-time

17 FWs

1 CPN

1 Physio assistant

1 Special Educationalist

1 driver

Part-time

1 consulting psychiatrist^‡

Full-time

2 social workers

3 nurses

1 field worker

Part-time

1 psychiatrist

Non-clinical staff

6 Brothers of Charity; 2 security guards; 1 driver; 1 maintenance person; 1 cook; 1 laundry person

Full-time

2 social workers

Part-time

2 psychiatrists^§

1 psychologist^§

1 social worker^§

10 CVs

Services for People With Disabilities

Holy Face Rehabilitation Center for Mental Health

Asia Psychosocial Rehabilitation Program

PATHWAYS TO CARE

Active presence of FWs in the community; community clinics.

Enrolled 76 new clients (2008): 80% epilepsy, 20% psychosis.

No direct outreach. Have trained community health workers who, in turn, refer clients.

354 new clients (2008); 119 new clients (first six months of 2009). Data (2007) suggest ≈80% of new clients have schizophrenia, remainder appear to have major depressive disorder.

2009:

House-to-house surveys in catchment areas (≈2,000 house visits)

Cases detected = 181

• CMD = 94

• Psychosis = 55

• Other = 32

New cases recruited = 60

• CMD = 33

• Psychosis = 13

• Other = 14

FWs and CPN will hold periodic meetings in local churches; FWs will consult with parish priests and village chiefs

Social workers and nurses will hold periodic community workshops and mental health trainings for local government health workers and NGO community volunteers

All staff participate in community meetings; consultations with parish priests

Home visits by FWs; follow-up treatment during home visits by CPN or community clinics

Every week, FW looks for clients who have not returned to outpatient clinic; presence of local government and NGO health workers in the community.

Follow-up treatment in weekly outpatient clinic.

Home visits by CVs; follow-up treatment in community clinics and/or at the hospital

CLIENT CHARACTERISTICS

≈88 per month (2008)**

354 new clients (2008)

119 new clients (Jan-May 2009)^††

Since 2004,120 admitted to residential facility & about 1,800 seen as outpatients (as of May 2009)

70 to 120 patients are seen in the outpatient clinic each week

Inpatient facility never has more than 20 residents.

2009:

Colachel: 90 received services, and, of these, 25 received inpatient treatment and followed-up in the community. 30 active clients as of December.

Pozhiyoor: 35 clients received services; of these, 5 received inpatient treatment.

Thuthoor and surrounding areas: 42 clients received services. Of these, 22 accessed care first at the hospital and subsequently followed in the community.

TOTAL = 167

Epilepsy (≈75%) & psychosis

Psychosis & CMD

CMD (≈50%)

Psychosis (≈25%)

Other disorders (≈25%)

INTERVENTIONS

Older psychotropic medications

Older psychotropic medications

Full range of psychotropic medications; specialist psychotherapy and non-specialist counseling

Services for People With Disabilities

Holy Face Rehabilitation Center for Mental Health

Asia Psychosocial Rehabilitation Program

SHGs (3)

FSGs; livelihood activities Supporting FSGs in 4 municipalities and 1 island in Albay Province (as of June 2009)

SHGs; livelihood activities; prevention and promotion groups; community workshops 14 SHGs with a total of 204 members, of whom 36 (almost 18%) were clients and caregivers (Nov 2009).