MEDICAL humanitarian organisation, Medecins Sans Frontieres/ Doctors Without Borders (MSF) have established an effective community mental health model of care in 12 polyclinics and one satellite clinic in Harare to enhance the provision of mental health care in the community.
The community mental health care model is a pilot programme that was started by MSF in April 2016 in collaboration with the Ministry of Health and Child Care (MoHCC), the City of Harare health department and the University of Zimbabwe College of Health Sciences, Department of Psychiatry. It involves moving treatment, care and support for patients with mental illness from the hospital to community-based polyclinics.
MSF piloted the community model after conducting an assessment that revealed a lack of mental health care at the community level, had led to repeated hospitalisation and imprisonment of patients with mental illness.
“We noted that patients who were being discharged from the psychiatric institutions were relapsing when they went back into the community, due to lack of adequate treatment, care and support, and were being re-admitted into psychiatric institutions,” said MSF Head of Mission for Zimbabwe, Abi Kebra Belaye.
“We also conducted a nationwide rapid assessment and noted that there were serious health gaps in the country’s psychiatry care system including shortage of psychotropic drugs, human resources (specialists) and physical facilities, particularly at primary health care / community level.
“We decided to set up a discharge team that comprised a psychiatrist, a mental health nurse and a social worker that followed up patients with mental illness after their discharge from Chikurubi and Harare Central Psychiatric units and connected them to the relevant health facility at their community,” said Ms Belaye.
The community model is an innovative, cost-effective intervention because patients live at home and get their treatment from their local polyclinic, which helps them cut down on transport costs.
MSF also successfully supported the development and launch of the Mental Health Discharge Plan guidelines to ensure that there was a clear referral pathway for mental patients that are discharged from the psychiatric institutions to the polyclinics.
The discharge team has also provided training to polyclinic nurses so they can respond to mental ill health even in the absence of the discharge team. The team also provided mentorship to the nurses. “We allowed them to take the lead in the consultations and we provided support whenever they needed it so that they build up on theoretical knowledge from the WHO’s mental health Gap (mhGAP) intervention guide training,” said Dr Michelle Dube, consultant psychiatrist.
MSF is confident that the existing staff in the polyclinics will be able to provide good quality care despite continuing challenges.
When a programme has been supported through the growth and development phase, MSF hands over project activities so that patients continue to receive uninterrupted treatment.
“We call upon MOHCC, donors and other NGOs to cascade the community model across the country so that people with mental illness benefit from services,” said Ms Belaye.
Meanwhile, MSF also handed over its community mental health project activities to the University of Zimbabwe, Department of Psychiatry. In addition, MSF also donated a Toyota Landcruiser, medicines, office space, furniture, stationery, a computer and a printer.