Framework for Mental Health Care Country Situation Analysis

Framework for Mental Health Care Country Situation Analysis

1. Introduction

- Brief introduction to the country eg politics, socioeconomic indicators (if not part of the overall report). How this situation analysis fits into the overall report being compiled.

- Demographic information; population, age ranges, male/female split etc

- Brief history of mental health care in country; eg pre-colonial, colonial, post-colonial.

2. Mental Health needs

- Epidemiological information about mental illness, especially prevalence, common conditions presenting

- Specific risk factors in country that leads to greater risk of mental illness (poverty, war, domestic violence, poor maternal and child health, alcohol/drug use etc).

- Pathways to care. What are the common beliefs about mental illness in the country? Where do most people go for care initially?

- What is the human rights situation for people who develop mental health problems?

- How easy is it for people to access care?

3. Mental Health policy

- Governance: How is implementation of government mental health services managed? Is there a specific department in the MOH? Who runs this?

[It may be useful here to include a diagram/organogram of the mental health leadership structure in the country]

- Does the country have a national mental health policy?

- How old is it?

- What does it contain? Is it up-to-date and relevant?

- Is it implemented at all?

4. Legislation protecting the rights of people with mental illness

- Does the country have relevant legislation (specific to mental health or incorporated in other human rights legislation)?

- How old is it?

- What does it contain? Is it up-to-date and relevant?

- Is it implemented at all? Are relevant people aware of it, including professionals who should use it like doctors and lawyers?

- What is the situation for people with mental health problems in prisons or who commit a crime and go to court?

- Any inclusion of persons with psychosocial disabilities in other relevant legislation/ UNCRPD processes?

5. Mental health financing

- How are government MH services funded?

- % of total health budget? What % of total government budget is health?

- Other significant externally funded programmes, or external support for government services?

- What is the payments system? Do patients need to pay? Is this expensive for them? Does it mean that some people cannot access care?

6. Mental health services available in the country

- Introduction summarizing overall health system structure, and how mental health services fit into this.

- Are the services generally accessible?

- Is there any community-based care available for follow up care?

Type of service/Institution / Number / Comments
Staff levels, condition of wards etc
Psychiatric hospitals
General Hospitals with psychiatric departments
Community-based mental health service
Prisons with MH services

[A map of the country with locations of relevant institutions/services is useful]

7. Human Resources for mental health

- Introduction about general situation.

- Are there sufficient personnel at different levels of the health system? Are they evenly spread in the country?

- Training provision for mental health professionals. Where do they train? How many each year?

- Do they work effectively? Private practice?

- What is the capacity of general practitioners (doctors and nurses) to provide mental health care?

Profession / Number / Comments
Psychiatric nurses
Psychiatrists
Psychologists
Occupational Therapists
Psychiatric social workers

8. Specialist Mental Health Services

- Child and adolescent mental health services. ? Any specialists or specialist units?

- Services for the elderly

- Drugs and alcohol services

- Forensic services

9. Availability of Drugs

- Are essential psychotropic drugs (as recommended by WHO) available in the country?

- Who is allowed to prescribe? Who prescribes in practice?

- What are standards of prescribing like?

10. Organizations working in mental health

- List relevant organisations including local and international NGOs,organisations representing the interests of people with mental illness. Does WHO participate actively in MH issues in the country?

- What CBM-partners work in the field of mental health? What types of projects are they?

- Are PW Psychosocial Disabilities included in work of other DPOs (eg national DPO umbrella body)?

- Are they consulted in issues relevant to them at national or local level?

- Is there a national alliance of people or organisations working in mental health

11. Stakeholders views

It is important to seek the views of relevant stakeholders when preparing a situation analysis. Relevant stakeholders might include:

-Users of services, family members

-Psychiatrists

-General practitioners

-Psychiatric nurses

-Relevant Ministry officials

-Social workers/occupational therapists where they exist

-University lecturer/academic

-Relevant NGOs / DPOs

Interviews with these key informants (alone or in groups) should be conducted to find out what relevant stakeholders think about mental health care in the country. Some relevant issues to raise might be:

-The effect of mental illness on the lives of people in the country who have these problems.

-How easy it is for them to access care

-Where they think services are good enough, accessible, and meet their needs.

-What they think could be done to improve the situation.

-The human rights situation. Discrimination.

12. Summary of Challenges and Recommendations

- Based on the desk research and interviews. These challenges and recommendations may be the opinion of the writer of the report, and this should be stated where this is the case.

13. Relevant References/Source Materials

- Reports, research, internet links

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