Global Mental Health

MhINT in South Africa

Common mental disorders (CMDs), such as depression, anxiety, and alcohol use, are highly comorbid with other diseases and conditions. In South Africa, approximately 16.5% of the population suffer from CMDs and these rates are further elevated among persons living with HIV, TB and other chronic diseases.1 2 Only one in four South Africans have access to mental health treatment of any kind. 3

To combat these staggering barriers, I-TECH and global mental health faculty developed the Mental Health INTEgration (MhINT) Program. The MhINT Program scales up evidence-based collaborative care for CMDs throughout three districts of South Africa. Counselors provide psychosocial counseling for depression and ART adherence within the current primary health care system. Thus reducing the gap for both mental health treatment and improving adherence in HIV care.


Implementation science for mental health system improvement in Mozambique

Even in Mozambique, a country with 2.1 million individuals living with HIV, high rates of other infectious diseases, limited public-sector health workers, and low overall levels of human development (180/189 countries globally), mental disorders are estimated to account for more years lived with disability for those 14-49 than HIV, TB, diarrhea, pneumonia, malaria, neglected tropical diseases, neonatal & maternal conditions combined. In 2014, the WHO listed Mozambique as having the highest suicide rate in Africa and the 7th highest in the world, with a rate more than double the global average. Mozambique has 13 Mozambican psychiatrists to serve the needs of a population of nearly 30 million. However, Mozambique has been a leader in task-shifting, training “technicians of psychiatry” in a two-year program since 1996 – although nationally there are only 270 technicians (one provider for each 110,000 population).

To address these gaps and challenges, the University of Washington (UW) in partnership with Health Alliance International (HAI) have been working hand-in-hand in solidarity with the Mozambican Ministry of Health on applied implementation science projects for public-sector mental health systems improvement since 2013. Currently they are:

  • Developing and pilot-testing a systems engineering implementation strategy including care cascade analysis tools and the use of open-source electronic medical record software in public-sector clinics with mental health and non-mental health professionals.
  • Conducting the first-ever demonstration project of providing integrated screening, care, and treatment for common and severe mental health problems for people testing HIV+ in Mozambique.
  • Conducting a multi-pronged study with the aim of improving the integration of mental health care and primary care in Mozambique.
  • Engaging in a capacity building project to train Ministry of Health staff in implementation science for global mental health systems improvement

 

  1. Williams D, Herman A, Stein D, et al. Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study. Psychological medicine. 2008;38(2):211-220.
  2. Freeman M, Nkomo N, Kafaar Z, Kelly K. Factors associated with prevalence of mental disorder in people living with HIV/AIDS in South Africa. AIDS care. 2007;19(10):1201-1209.
  3. Seedat S, Williams DR, Herman AA, et al. Mental health service use among South Africans for mood, anxiety and substance use disorders. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde. 2009;99(5 Pt 2):346-352.