https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60891-X.pdf

Scale up of services for mental health in low-income and middle-income countries.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61458-X.pdf

Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis

Orientation among multiple truths: An introduction to qualitative research

The effect of food insecurity on mental health: Panel evidence from rural Zambia

Background: While stigma measurement across cultures has assumed growing importance in psychiatric epidemiology, it is unknown to what extent concepts arising from culture have been incorporated. We utilize a formulation of culture—as the everyday interactions that ‘matter most’ to individuals within a cultural group—to identify culturally-specific stigma dynamics relevant to measurement. Methods: A systematic literature review from January 1990 to September 2012 was conducted using PsycINFO, Medline and Google Scholar to identify articles studying: (i) mental health stigma-related concepts; (ii) � 1 non-Western European cultural group. From 5292 abstracts, 196 empirical articles were located. Results: The vast majority of studies (77%) utilized adaptations of existing Westerndeveloped stigma measures to new cultural groups. Extremely few studies (2.0%) featured quantitative stigma measures derived within a non-Western European cultural group. A sizeable amount (16.8%) of studies employed qualitative methods to identify culture-specific stigma processes. The ‘what matters most’ perspective identified cultural ideals of the everyday activities that comprise ‘personhood’ of ‘preserving lineage’ among specific Asian groups, ‘fighting hard to overcome problems and taking advantage of immigration opportunities’ among specific Latino-American groups, and ‘establishing trust among religious institutions due to institutional discrimination’ among African-American groups. These essential cultural interactions shaped culture-specific stigma manifestations. Mixed method studies (3.6%) corroborated these qualitative results.

/pdf/recent-advances-in-cross-cultural-measurement-in-psychiatric-4uuz69gk35.pdf

Recent advances in cross-cultural measurement in psychiatric epidemiology: utilizing ‘what matters most’ to identify culture-specific aspects of stigma

Objective: The aim of this qualitative study was to explore the presence, causes and means of addressing individual and systemic stigma and discrimination against people with mental illness in Zambia. This is to facilitate the development of tailor-made antistigma initiatives that are culturally sensitive for Zambia and other low-income African countries. This is the first in-depth study on mental illness stigma in Zambia. Method: Fifty semi-structured interviews and 6 focus group discussions were conducted with key stakeholders drawn from 3 districts in Zambia (Lusaka, Kabwe and Sinazongwe). Transcripts were analyzed using a grounded theory approach. Results: Mental illness stigma and discrimination is pervasive across Zambian society, prevailing within the general community, amongst family members, amid general and mental health care providers, and at the level of government. Such stigma appears to be fuelled by misunderstandings of mental illness aetiology; fears of contagion and the perceived dangerousness of people with mental illness; and associations between HIV/AIDS and mental illness. Strategies suggested for reducing stigma and discrimination in Zambia included education campaigns, the transformation of mental health policy and legislation and expanding the social and economic opportunities of the mentally ill. Conclusion: In Zambia, as in many other lowincome African countries, very little attention is devoted to addressing the negative beliefs and behaviours surrounding mental illness, despite the devastating costs that ensue. The results from this study underscore the need for greater commitment from governments and policy-makers in African countries to start prioritizing mental illness stigma as a major public health and development issue. Key words: Mental health; Stigma and discrimination; Qualitative study; Zambia

/pdf/mental-illness-stigma-and-discrimination-in-zambia-3qt5wtfv5g.pdf

Mental illness - stigma and discrimination in Zambia

Objective: The aim of this study was to explore health care providers’ attitudes towards people with mental illness within two districts in Zambia. It sought to document types of attitudes of primary health care providers towards people suffering from mental illness and possible predictors of such attitudes. This study offers insights into how health care providers regard people with mental illness that may be helpful in designing appropriate training or re-training programs in Zambia and other low-income African countries. Method: Using a pilot tested structured questionnaire, data were collected from a total of 111 respondents from health facilities in the two purposively selected districts in Zambia that the Ministry of Health has earmarked as pilot districts for integrating mental health into primary health care. Results: There are widespread stigmatizing and discriminatory attitudes among primary health care providers toward mental illness and those who suffer from it. These findings confirm and add weight to the results from the few other studies which have been conducted in Africa that have challenged the notion that stigma and discrimination of mental illness is less severe in African countries. Conclusion: There is an urgent need to start developing more effective awareness-raising, training and education programmes amongst health care providers. This will only be possible if there is increased consensus, commitment and political will within government to place mental health on the national agenda and secure funding for the sector. These steps are essential if the country is improve the recognition, diagnosis and treatment of mental disorders, and realize the ideals enshrined in the progressive health reforms undertaken over the last decade.

https://www.ajol.info/index.php/ajpsy/article/download/70284/58526

Attitudes of primary health care providers towards people with mental illness: evidence from two districts in Zambia

Background
Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services.

/pdf/integrating-mental-health-into-primary-health-care-in-zambia-1qostknqbi.pdf

Integrating mental health into primary health care in Zambia: a care provider's perspective

Despite radical health transformations in Zambia over the last decade, mental health continues to be marginalized, as reflected in the un-coordinated and under-resourced mental health care system. This paper presents the qualitative results of a situation analysis conducted as part of the first phase of the Mental Health and Poverty Project. The aim of this paper was to explore what a range of stakeholders perceive as the main challenges facing Zambia's mental health system and the primary ways of addressing them. Fifty interviews and six focus group discussions were held with policy makers in and outside of the ministry of health, general and mental health care professionals, users of psychiatric services, teachers, police officers, academics, members of three NGOs and traditional healers. The major challenges identified included: marginalization of mental health; flawed policy development; outdated and harmful legislation; human rights abuses, including stigma; limited mental health services; and inadeq...

Stakeholders' perceptions of the main challenges facing Ghana's mental health care system: a qualitative analysis

Human resources for mental health care in low- and middle-income countries are inadequate to meet the growing public health burden of neuropsychiatric disorders. Information on actual numbers is scarce, however. The aim of this study was to analyse the key human resource constraints and challenges facing Zambia's mental health care system, and the possible solutions. This study used both qualitative and quantitative methodologies. The WHO-AIMS Version 2.2 was utilized to ascertain actual figures on human resource availability. Semi-structured interviews and focus group discussions were conducted to assess key stakeholders’ perceptions regarding the human resource constraints and challenges. The results revealed an extreme scarcity of human resources dedicated to mental health in Zambia. Respondents highlighted many human resource constraints, including shortages, lack of post-graduate and in-service training, and staff mismanagement. A number of reasons for and consequences of these problems were highligh...

Augustus Kapungwe

Papers

Mental illness - stigma and discrimination in Zambia

Attitudes of primary health care providers towards people with mental illness: evidence from two districts in Zambia

Integrating mental health into primary health care in Zambia: a care provider's perspective

Stakeholders' perceptions of the main challenges facing Ghana's mental health care system: a qualitative analysis

Human resource challenges facing Zambia's mental health care system and possible solutions: Results from a combined quantitative and qualitative study