Where There Is No Psychiatrist
The newly published second edition of Where There is No Psychiatrist is a practical manual of mental health care for community health workers, primary care nurses, social workers and primary care doctors, particularly in low-resource settings. Authors Vikram Patel and Charlotte Hanlon discuss the importance of this manual below.
Where do you start when only 1 in 10 people with a mental health problem can access evidence-based treatment? That is the challenge we face in Ethiopia, in common with most other low-income African countries. Not getting treatment has stark consequences, putting people with mental health problems at risk of premature death, homelessness, abuses and exploitation, stigma and impoverishment. That was the starting point for the World Health Organisation’s mental health Gap Action Programme (mhGAP) – to expand access to evidence-based mental health care.
The mhGAP approach is to make sure that mental health care is integrated into all healthcare. In Ethiopia, that means equipping community health workers, nurses, midwives, health officers, general doctors, and so on, so that they feel comfortable and competent to deliver mental health care according to their level. The Ethiopian government has embraced this approach and has committed to scale-up mental health care, but the big question is about how this can be achieved in practice. The mhGAP guide provides clear clinical guidelines for health workers; Where there is no Psychiatrist provides a hands-on manual and step-by-step information on how to actually do it. As an example, when a person comes to a rural health centre in Ethiopia, they rarely would complain of being ‘depressed’. Instead, they might complain about a chronic headache or tiredness or sleep problems. The symptom-based approach in WTINP helps the health worker to identify the underlying problem (e.g. depression or anxiety) and then provide the appropriate care. Making counselling and social interventions more understandable to health workers is also really important if we are to avoid medicalising mental health care – in WTINP we have tried to provide health workers will all the tools they need to deliver psychosocial interventions as part and parcel of usual care.
Photo Credit: Sharmila Coutinho (Cover illustration of Where There is No Psychiatrist, 2nd Edition)