Peer Nation Concept Paper
for Peer Support Working Programme
BACKGROUND OF THE PROBLEM
Mental illness presents as a major burden to societies with substantial distress to affected individuals, families, communities and resulting in high social, human and economic costs (Wait Harding 2006, Dewa et al 2007)
The prevalence of mental illnesses in the Ugandan population is estimated at 35% compared to 13% worldwide prevalence with 3% prevalence of severe mental illness (Demyttenaere 2004). Many low income countries like Uganda lack the adequate human and financial resources to provide specialized mental health care for people affected by severe mental illness (Kigozi et al 2010). Specialized mental health services are mainly located in urban areas not easily accessible to many people who, worse still lack information about mental health. Challenges in accessing formal treatment include: long distance from health facilities, frequent medication stock outs, family negligence and shortages in human resource, preference of traditional healers and spiritual healers as first contact in attempt to seek for healing. This has always caused delay in the process of recovery.
In 2010, Uganda had only about 1.13 health personnel per 100,000 with all cadres included: like psychiatrists, psychologists, social workers, resource occupational therapists, nurses and other medical workers (Kigozi et al 2010). The current situation shows that it has even lowered to 1.02 per 100,000 indicated as follows: 0.08 psychiatrists, 0.2 psychiatry clinical officers, 0.01 psychologists, 0.78 nurses, 0.04 other medical doctors, 0.01 occupational therapists and social workers. This is by all standards far below the average ratios of many nations (Kigozi et al 2010). In addition, the mental health sector receives only 1% of the health sector budget finance and much of this finance goes to the national referral mental health hospital of Butabika, making it almost impossible to handle most mental health challenges and eventually building up a gap in service delivery and affecting the delivery of community mental health services.
It may therefore be helpful to explore the integration of Peer Support Workers (PSWs), who are defined as people with a lived experience in mental health and have accepted to openly share their experiences for the benefit of others who are still stricken under the power of self-stigma and poverty. They are to be integrated in the government health sector to bridge the gap in human resource (staffing shortages through co-production in these low income countries and to tap or benchmark their enriched experience as a tool for recovery). It is this experience of PSWs that shall empower and inspire those service users who are still reserved about their mental health status to realize that recovery is possible and can become productive.
Community mental health services are not well established in Uganda due to the lack of qualified staff. This is a contributing factor to the gap in knowledge about mental health in the communities.
A lot of effort has been put together to cover the deficit in community mental health outreach to provide care and support by carrying out mental health outreaches to specific lower grade health centers and communities, as in trying to bring services closer to the people. However, the problems listed below still exist, and are affecting the provision of effective community mental health service delivery that is worsened by the endemic poverty prevalent in LMIC of which Uganda is one.
- Limited number of professional staff
- Language barriers
- High level of drugs stock out
- Stigmatization and discrimination in the family, work place and the community
- Death of peers due to suicide, mob justice and homicide
- Poor community mental health awareness
- Social isolation within communities
- Long distances to medical services
These problems are partly aggravated by stigma in the family and community due to lack of sensitization on mental health issues. Few people in the communities have knowledge about mental illness and little has been done to sensitize them.
Social workers and community nurses have been carrying out resettlements quite often to reduce further health care burden. However, little has been done in regard to the follow up of these service users, and there is also no rehabilitation plan. In addition, there is a great gap in family engagement at the community level.
This project intends to bring PSWs on board by establishing a working relationship with government structures. Working with PSWs will help to empower service users in the community. This will be done to facilitate recovery at the community level with the following goals: to reduce frequent hospitalization, relapse and readmissions in mental health facilities, to increase adherence to medication, to create a network for recovery purposes, to instill hope and independence in peers, to bridge human resource gaps, to strengthen community mental health service delivery, etc.
- To improve the level of community understanding on issues affecting mental health service users
- To increase the capacity, knowledge and confidence of PSWs in managing mental illness using their lived experience
- To bridge the gap between mental health professionals and service users using their lived experience as a tool
- To instill hope among the service users by gaining financial independence through income generating activities such as beading and other talent-oriented Arts
To improve level of community awareness and understanding of issues affecting people with mental health Challenges.
- To increase knowledge and confidence of service users in promoting recovery using lived experiences.
- To bridge the gap between service users and mental health professionals through co-oproduction.
- To empowering service users with skills of livelihood and income generation so as to promote their independence and eventual autonomy.
- To collaborate in continued research and development in mental health particularly service user involvement and peer support working.
- To collaborate with key stakeholders and strategic partners within national, regional and global spheres on matters of mental health recovery and income generation
- To foster service user family reintegration and community engagement after discharge from Hospital.
- To create avenues and a platform for recreation and social interaction amongst fellow service users and the general populace so as to realise and enjoy recovery.
- To mobilize resources through income generating activities, fundraising and seeking donations to enable Peer Nation Limited achieve the above stated objectives.
- Empowering users with hands-on skills such as beading
- Having peers allocated to suitable PSWs
- Making first contact while the service users are still on the ward
- Visiting the peers in the community
- Meeting family members and discussing the service user’s recovery
- Compiling reports after every meeting
- Identifying model Regional Referral Hospitals where to train more service users to become PSWs
The project will be implemented by engaging Peer Support Workers and hospital staff in co-production & co-delivery of mental health services. The PSWs could be incorporated in the hospital, PCO & Nursing school timetables for continuous recovery oriented educational sessions as part of their routine programmes. Community leaders, family members, relatives & friends shall also be encouraged to join in recovery health talks whenever PSWs make family visits, and at community gatherings such as places of worship or social events.
Quarterly reports shall be submitted to the responsible office as accountability to the funders.
Monthly meetings by both hospital staff and PSWs shall be held to check on wellness, discuss challenging cases and to seek solutions from the group.
This project intends to work within a budget line of UGX 50 million to cover set up and running costs such as utilities, transport costs, office rent and equipment, plus other amenities for a duration of one year to start with. This could then be sustained into an on-going programme through the income generating activities. Some of the funds will be used to formalize the registration of the Peer Nation organization with Uganda government statutory bodies.
Being aware of the current situation that mentally ill patients go through in Uganda, our organization, Peer Nation will try to address some of the problems highlighted above. But primarily we intend to fill the vacuum of mental health care in the community through peer support, particularly talk therapy as opposed to over medicalizing the condition, which is the common practice that starts straight from the medical training institutions in the country. We intend to achieve this by promoting the recovery model using the methodology above so that the service users regain their lives and have meaning and a purpose in life.