Benchmarking a model of culturally adjusted model of care in Zimbabwe for service development in Gangs and Mental Health Interventions in the NHS.
Aim:
The overall objective of this study was to explore the context in which an HIV-Psychological model of care that uses culturally adjusted interventions and has proved effective in managing and reducing burden of mental health and treatment gap in Zimbabwe can inform and enhance our culturally adjusted interventions in our clinical work with young people and families affected by gang culture in London for service development in the wider National Health Service.
Background:
Common mental health disorders are a leading cause of disability globally [1] In the UK, ethnic minority groups are over represented in the mental health services. They are more likely to have greater disability and effectively accessing services. Culture is closely tied to health outcomes. In my clinical practice clients often present with co-morbidities of substance misuse, sexual violence, safeguarding issues, medication adherence, developmental problems, HIV, prevention of female genital mutilation, Post Traumatic Stress Disorder and physical health complications. A high proportion of clients and families in my service line are from minority groups. Migration presents an added risk factor in terms of change and adaption to new socio-cultural environments, language and adaption of parenting skills and styles. Culture shapes the level and quality of engagement and therefore clinical outcomes.
The Friendship Bench program in Zimbabwe uses a Shona Symptoms Questionnaire (SSQ) is an indigenous measure of common disorders and is effective in addressing and managing common mental health disorders. The questionnaire, which was developed from ethnographic and qualitative studies elicited idioms of distress in mental disorder in populations with high exposure to HIV and social challenges, and subsequently led to the establishment of the Shona Symptom Questionnaire (SSQ). A randomised control study subsequently provided the evidence base for the effectiveness of the use of SSQ. From the SSQ a Cognitive Behaviour Therapy which is culturally adapted, is to address complex social issues compounding mental health orders in the local population. The Friendship Bench program is now being scaled up to 80 primary care clinics in Zimbabwe; During my visit I was involved in the training of the Community Health workers who will be delivering the intervention to a wider population.
Methods:
The qualitative study involved semi-structured interviews with Community Health Workers (CHW) who are delivering mental health care in a high density area in Harare, Zimbabwe using the SSQ and the Problem Solving tools. These CHW who are extensively experienced at delivering mental health care were interviewed to gather their ideas and experiences of delivering culturally adjusted methods of care with a view to incorporate their views in developing our culturally adjusted interventions in our Gangs-CAMHS work in London.
Research ethics to carry out a qualitative study on the Friendship Bench was sought and approved by the Medical Research Council of Zimbabwe.
I participated in the teaching and guiding Community Health Care Workers who were being trained in the scale up Friendship Bench program. In my capacity as a Florence Nightingale scholar, I conducted four comprehensive mental health training in two separate hospitals using the WHO Mental Health Gap Training Manual. The teaching sessions focused on the topics of ‘Assessment and Management of Suicide and Self Harm in clinical practises’ and ‘Safeguarding issues for vulnerable individuals’ The teaching sessions were useful in extrapolating different meanings that clinicians and wider society place on the role of culture as a risk factor and protective factor in determining health outcomes.
Clinical Settings visited:
- 10 Qualitative interviews were carried out at Mbare Poly Clinic in Harare, Zimbabwe
- WHO Mental Health Gap Training sessions were carried out in Ingutsheni Hospital, Bulawayo, Zimbabwe
- Training to scale up Community Health Workers was conducted at Harare General Hospital.
- Visited Mpilo General Hospital in Bulawayo, spent time on the HIV Child and Adolescent Department, and General Admissions ward.
- WHO Mental Health Gap Training carried out in Chitungwiza, also met with two Commonwealth Nurses whom I mentor.