Belgian Platform for International Health    ENG | FR

Be-cause health matters 14

Mental health voices from Africa: experiences and lessons learned

Workshop

User participation in mental health services

The fact that mental health services are still underdeveloped in Africa raises, among other issues, the question of user participation. Communities’ perception of mental health issues, the role and degree of participation of people in their care or the lack of knowledge of their rights, are emerging and yet fundamental questions.

Togo & Madagascar

The speakers gave us examples from Togo with Barthélemy KOUKOURA and from Madagascar with Patrick RAZAFINDRADIMY. One thing was unanimous; the social participation of mental health users still has a lot of progress to make. Moreover, the range of available mental health services is insufficient (there is only one psychiatric centre in the whole of Togo) and these same services are often very negatively perceived by communities and the people who live in them.

In Togo, the response had focused on strengthening many health professions (nurses, psychologists, social workers, medical assistants, etc.) and creating community-based multidisciplinary mental health care services. In Madagascar, the example of care in prisons was based on several socio-anthropological studies and exploratory missions. On the basis of this precise assessment, which had been carried out by a complaints committee, individual and group support was provided, revealing that the well-being and self-esteem of the prisoners improved, support staff saw their work made easier, and the quality of the psychosocial service increased considerably.

Watch the video of Mr. Barthélemy Koukoura (Togo)
Watch the video of Mr. Patrick Razafindradimy (Madagascar)

Guinea

Abdoulaye SOW launched a discussion in which he spoke as a discussant. He synthesised these two presentations with examples from Guinea, his home country. He first pointed out that the needs of mental health systems in many African countries are similar in terms of availability, access to care and services and respect for human rights.

On the Togolese example, Abdoulaye SOW noted that organisational strengthening and support for the groups through training, advocacy and emotional support had boosted patients' self-esteem, while emphasising the necessary but often paradoxical involvement of the State. This was necessary because through the State’s help it is possible to improve the general population’s mental health, but there is also a paradox because, according to Abdoulaye SOW, "we mustn’t delude ourselves because unfortunately mental health issues are not a priority despite their importance in terms of morbidity and disability. This is why the greatest challenge today is how to encourage people to organise themselves to create useful spaces for the development of high quality mental health services".

In the Malagasy example, where detention facilities are located and the condition they are in were factors contributing to deteriorating mental health of the prison population. The discussant welcomed this "innovative" initiative, particularly in view of the difficulties of intervening in the prison environment; he used the example of the central prison in Conakry, where similar issues had been reported, to point out that support, whether during incarceration or after release, was "a complex but useful process for reintegrating [the prisoner] into active life".

How to improve the offered quality of services?

1

Involve users in administering their care.

2

Develop joint efforts between international institutions, the countries, medical structures, users, their families and their communities.

3

Create bridges between conventional and traditional medicine.

4

Strengthen the skills of the health professionals for better care.

5

Implement the preventive activities as a complement to curative care.

6

Diversify activities.

These two examples show that when users are involved in administering their care, the quality of the services offered is improved. In addition, there is a) the need to develop joint efforts between international institutions, the countries, medical structures, users, their families and their communities; b) the prospect of creating bridges between conventional and traditional medicine; c) the strengthening of health professionals skills for better care; d) the implementation of preventive activities as a complement to curative care; e) the diversification of activities, which may include discussion groups in prisons, rehabilitation and reintegration programmes for users in the communities, and community awareness-raising activities to combat the stigmatisation of mental health users.

"The fight against the precariousness of users treated by economic reintegration activities strengthens the resilience of users and contributes to the respect of the rights of people transversally"

- Patrick RAZAFINDRADIMY

The post-presentation exchanges even saw a participant ask the question about raising awareness among local populations as well as the role that local government and local actors (churches, schools) could play in this awareness-raising; this was in line with the cross-cutting issues of cooperation and the organisation of care resources. In all the observations and recommendations shared, we noted the importance of capacity-building for users in order to boost their participation in the projects affecting them, but also their participation in society, through individual support and by encouraging their networking and the creation of users' groups.