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

From: Three models of community mental health services In low-income countries

  Services for People With Disabilities Holy Face Rehabilitation Center for Mental Health Asia Psychosocial Rehabilitation Program
HISTORY & CONTEXT
Established 2006 2004 2005
Location 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
Geographic area 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
Population 1.4 million[29] Albay Province: 1.3 million Bicol Region: 5.7 million [30] 100,000
Socioeconomic Context Low-income, but within a region of great economic inequalities Low-income Mostly low-income
Human Development Index .511 (Nigeria) [31] .577 (Albay Province) [32] .763 (Kanyakumari, TN) [34]
    .775 (Kerala) [33]
ORGANIZATION
Model 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
Funding • 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
Management Director
Administrative Assistant
Director
2 Administrative staff
Director Project
Officer
1 Program Coordinator
Staff 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
Case-finding 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
Outreach 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
Follow-up 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
Number ≈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
Clinical characteristics Epilepsy (≈75%) & psychosis Psychosis & CMD CMD (≈50%)
Psychosis (≈25%)
Other disorders (≈25%)
INTERVENTIONS
Clinical 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
Psychosocial interventions 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).
  1. * Does not include areas added in 2010-2011
  2. Dr Somervell Memorial CSI Medical College & Hospital provides a portion of staff salaries, as well as administrative and infrastructure support. Patients are eligible to buy insurance that is subsidized by the college. This will partially cover costs of the program.
  3. CBM Mental Health Advisor, supporting many similar projects, all of which receive occasional support visits.
  4. § These staff are based at the hospital and have duties that are not part of the program.
  5. ** Estimated from number of client visits in the year
  6. †† No information on number of active clients