University of York helps improve mental health care in Malawi

The University of York is leading a vital international project to establish community-based mental health care in Malawi, one of the poorest countries in the world.

Thanks to funding awarded under the UK Government’s Health Partnership Scheme, village-based health workers in 20 health centres in the Zomba District in southern Malawi, as well as other primary care staff, will receive bespoke mental health care training.

In Malawi, mental health need outstrips services and represents an immense treatment gap which urgently needs addressing.

The Mental Health in Zomba project (MHiZ), which has the support of the Ministry of Health in Malawi, aims to establish a community-based programme of mental health care by enhancing the role of village-based health workers – Health Surveillance Assistants (HSAs).

Led by Jerome Wright of the University’s Department of Health Sciences, the project builds on a smaller pilot study. This looked at how Malawi’s plan to de-centralise its limited mental health services and integrate it within primary care can be enhanced by moving mental health interventions into the roles of HSAs.

Jerome Wright said: “In Malawi, mental health need outstrips services and represents an immense treatment gap which urgently needs addressing. Our project looks at whether equipping Health Surveillance Assistants with new skills can improve community care by increasing the recognition of and response to people experiencing mental health problems.

“Our earlier pilot project showed that HSAs are ideally placed and willing to respond to mental health needs at community level, provided that the appropriate training is given, as well as on-going supervisory support and organisational backing.

“Thanks to the new funding, we are now able to test this initiative at a district-wide level and train 450 HSAs and 240 other health care professionals in mental health care. By monitoring and evaluating the initiative’s impact on patients and carers, HSAs, primary care staff and mental health services, we will gain a rigorous understanding of its potential as a major and sustainable community mental health programme.”

Zomba serves a population of 550,000 and the results of the project will be of interest not only in Malawi, but to international mental health providers in other developing countries faced with the same challenges.

With a shortage of 4.25 million health workers globally, the growing gap between the supply of appropriately trained health workers and the demand for their services is a key issue for underdevelopment and poverty worldwide.

Health Partnership Scheme awards allow skilled health professionals to teach and offer practical assistance to their counterparts in developing countries.

International Development Minister, Lynne Featherstone, said: “We are delighted to support the Health Partnership Scheme. Through the scheme, British medical expertise is used to help give developing countries the vital skills needed to improve the health of some of the world’s poorest people. The programme will train 13,000 overseas healthcare workers dealing with issues from trauma care to maternal health. British nurses, midwives and medical teams are amongst the best in the world and they will help make a real difference in some of the poorest parts of the world.”

Under the Mental Health in Zomba project, which runs until March 2015, Health Surveillance Assistants will receive training in providing treatment and support for people in their communities experiencing epilepsy, severe depression and suicide, psychosis and learning disabilities.

Jerome Wright said: “The project is not about exporting Western mental health practice, but about working with our Malawian colleagues to develop a culturally attuned training course which addresses local needs and is built around Malawian culture and village networks, such as the village health committees.”