Partners In Health

Unchained: Community-empowering, scalable mental health care for low-resource settings

Lead Organization

Partners In Health

Boston, Massachusetts, United States

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Mental health is essential for strong communities and economic growth, but poor mental health is the leading cause of disability worldwide. In low- and middle-income countries (LMICs), 90% of people cannot access mental health care, causing immense suffering, exclusion, and the literal chaining of individuals with treatable conditions. Through the Unchained project Partners In Health, CBM International, and the University of Global Health Equity will scale a proven model that equips non-specialists to deliver mental health care within their communities, empowers people with mental health conditions to advocate for themselves and support each other, and develops health system leaders. Unchained will give new hope to 11 million people in five countries burdened with mental health conditions stemming from poverty, genocide, war, and disaster by ensuring ongoing access to dignified care that improves well-being and restores communities. Unchained will drive sustained policy change by working with governments to challenge global norms.

Problem Statement

Mental health conditions are the leading cause of disability worldwide, and severe mental disorders in particular cause immense suffering and social exclusion. Approximately 90% of people with mental conditions in LMICs receive no treatment. In our target countries, recent collective trauma from war, genocide, natural disasters, colonial oppression, and high rates of poverty further compound the burden of mental health conditions.Health system development has focused almost solely on physical health, despite the essential contribution of mental health to overall well-being. Currently only 0.4% of development assistance for health in LMICs is spent on mental health care, and what little funding exists often supports locked institutions, which do not provide evidence-based treatments and perpetuate stigma and human rights abuses such as chaining. Severe shortages in trained clinicians, medications, strong mental health care protocols, and effective capacity-building approaches for mental health care further limits mental health care delivery.To create change, we must expand low-cost mental health care that provides treatment near people’s home communities instead of institutions. Empowering people with mental health conditions and their caregivers to advocate for themselves will unlock a huge community resource to improve quality of life and challenge stigma and exclusion. Good integration of local mental health care and self-help will improve community well-being and economic resilience. The investment pays off—every $1 investment in mental health care creates a $4 return on investment. Evidence of scalability of a solution can build on existing momentum to change global and national policy to transform care.

Solution Overview

The unchained solution combines PIH’s Mentorship and Task-sharing (MATS) and CBM’s BasicNeeds models to deliver effective and culturally sound mental health services. The project will utilize MATS in Rwanda, Liberia, Sierra Leone, Malawi, and Haiti to train and mentor non-specialist providers (e.g., nurses and community health workers [CHWs]) in mental health screening, education, and care delivery. Simultaneously, the project will build capacity and provide technical assistance to facility leads and policy-makers responsible for supervision, medication supplies, and referrals. Using the BasicNeeds model, staff will initiate self-help groups for service users referred by providers. Service users and caregivers will receive psychoeducation, peer support training, and access to shared livelihood interventions. This solution empowers service users to challenge stigma and promote inclusion in social lives of communities, while embedding capacity in the health system to meet mental health needs. In five years, the solution will: 1)increase the number of trained clinicians and managers delivering care and running programs, 2)provide access to effective care to over 11 million people in five countries, 3)enroll over 275,000 people in treatment to help them live healthy, productive lives,4)reduce rates of institutionalization,5)ensure positive outcomes from care (i.e. decrease in symptoms and improved ability to do everyday tasks, earn money, and advocate for their rights),6)create new national and global mental health plans, policies, and financing mechanisms by leveraging compelling project evidence to combat historical inaction of governments and funders. Overall, the solution will reduce suffering and increase global prosperity.

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