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). |