supporting community based mental health initiatives insights from a multi country CORD-Papers-2022-06-02 (Version 1)

Title: Supporting community-based mental health initiatives: insights from a multi-country programme and recommendations for funders
Abstract: Community-based mental health initiatives are uniquely positioned to understand the mental health needs of their local population and provide relevant culturally appropriate and sustainable responses. However at the grassroots level mental health initiatives in low- and middle-income countries face key challenges such as inadequate funding barriers to demonstrating impact and difficulty engaging with stakeholders. The Ember Mental Health programme establishes 12-month partnerships with community-based mental health initiatives in low- and middle-income countries to support them to address these challenges grow and achieve sustainability. This paper outlines a longitudinal qualitative study conducted to evaluate the 2020-2021 Ember Mental Health programme. Data were collected from March 2020 to March 2021 through semistructured interviews conducted with 11 initiatives at various time points throughout their Ember Mental Health partnership. A framework approach was used to analyse all data in its original language. Findings indicated that initiatives particularly benefited from provision of side-by-side mentorship; opportunities for skills strengthening and strategic thinking; occasions to network with other like-minded initiatives and/or experts in global mental health; and support on team empowerment and well-being. Based on these findings we put forward various recommendations for funders and other stakeholders working to support community-based mental health initiatives in low- and middle-income countries. Through establishing collaborative partnerships that challenge more top-down traditional fundergrantee relationships it is possible to support the rich ecosystem of initiatives working to address the mental health needs of communities.
Published: 2022-05-10
Journal: BMJ Glob Health
DOI: 10.1136/bmjgh-2022-008906
DOI_URL: http://doi.org/10.1136/bmjgh-2022-008906
Author Name: Larrieta June
Author link: https://covid19-data.nist.gov/pid/rest/local/author/larrieta_june
Author Name: Miguel Esponda Georgina
Author link: https://covid19-data.nist.gov/pid/rest/local/author/miguel_esponda_georgina
Author Name: Gandhi Yashi
Author link: https://covid19-data.nist.gov/pid/rest/local/author/gandhi_yashi
Author Name: Simpson Nikita
Author link: https://covid19-data.nist.gov/pid/rest/local/author/simpson_nikita
Author Name: Biriotti Maurice
Author link: https://covid19-data.nist.gov/pid/rest/local/author/biriotti_maurice
Author Name: Kydd Anna
Author link: https://covid19-data.nist.gov/pid/rest/local/author/kydd_anna
Author Name: Eaton Julian
Author link: https://covid19-data.nist.gov/pid/rest/local/author/eaton_julian
Author Name: Ryan Grace Kathryn
Author link: https://covid19-data.nist.gov/pid/rest/local/author/ryan_grace_kathryn
sha: 5eff9697dcf2472800b47eb68c42b0ed730c9def
license: cc-by-nc
license_url: https://creativecommons.org/licenses/by-nc/4.0/
source_x: PMC
source_x_url: https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 35537763
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/35537763
pmcid: PMC9092131
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9092131
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9092131/
has_full_text: TRUE
Keywords Extracted from Text Content: £ line Ember's Well-being Fund bodies human London School of Hygiene health-a SHM Foundation's participants resources-not people employees CBMHIs US$ stakeholders-particularly SHM UK funds improvement-yet peer-to-peer Guatemala languages [3] [4] [5] community-based mental health initiatives peer-topeer COVID-19 SHM Vikram Patel GME CBM JE Iona Gaskell GKR, Fahmy Hanna MB Competing Dan Chisholm Ashleigh Beukes human participants Rini Sinha Jara Lindsay, Joshua Olins
Extracted Text Content in Record: First 5000 Characters:The social and economic systems and structures that affect people's everyday lives play an important role in shaping their mental health. 1 2 While structural responses are needed (eg, poverty reduction strategies, policies ensuring the human rights of vulnerable populations are protected, etc), [3] [4] [5] community-based mental health initiatives (CBMHIs) also play an essential role in supporting local populations to identify and address risk factors, promote mental health and well-being and strengthen systems of care through specialised support. 6 CBMHIs are well positioned to understand the needs and priorities within their local contexts and are uniquely equipped to respond with relevant, culturally sensitive and sustainable strategies. 6 However, these initiatives face significant challenges, including insecure, restrictive funding often tied to burdensome administrative processes, 6 7 limited organisational capacityincluding capacity to apply for competitive funding calls-and difficulties demonstrating impact or disseminating their work to and engaging with stakeholders. Indeed, across all funding sources, resources allocated to mental health are low. ⇒ Community-based mental health initiatives play a unique and crucial role in addressing the needs of their communities, particularly in settings where access to other types of mental health services may be limited. ⇒ However, these initiatives often face the challenge of operating with very limited resources and support, hindering their sustainability and growth. ⇒ The Ember Mental Health programme was designed to address these challenges and offer tailored support to community-based mental health initiatives working in low-and middle-income countries. ⇒ First-hand accounts from implementers on the ground highlight key areas of support and outstanding challenges. ⇒ Concrete recommendations in the areas of mentorship, funding, well-being and networking are put forward for stakeholders-particularly funderspartnering with community-based mental health initiatives. Median government expenditure dedicated to mental health ranges from just US$0.02 per capita in low-income countries to US$2.62 in upper middle-income countries. 8 Further, available government funding does not always make its way into communities. In low-and middleincome countries, over 80% of mental health spending goes towards psychiatric hospitals typically located in urban areas, 8 and many district-level health planners lack any budget line for mental health. 9 Funding by global actors is also scarce. By 2017, only 0.4% of international development assistance for health was allocated to mental health (US$132 million) 10 -this may have decreased recently due to cuts in official development assistance from high-income countries and diversion to COVID-19 response activities. 11 Mental health also receives the lowest proportion (0.5%) of philanthropic development assistance compared with other health conditions. 12 Where funding is available, it may be granted for only short periods of time or with restrictions on when and how it can be spent, that make it difficult for CBMHIs to remain responsive to local needs and priorities. 7 13 Demonstrating impact is another resource-intensive task that is not always adequately costed and supported by funders, even when it is required as a condition of funding. 14 Showing how and to what extent initiatives are impacting the mental health of their communities is essential to service development and improvement-yet it requires technical expertise within teams that may not always be available. Further, the field of global mental health has traditionally focused on clinical and functional outcomes to measure impact. 15 However, these metrics are not always the most directly relevant or feasible for CBMHIs addressing contextual issues or systemic vulnerabilities to improve mental health, such as access to employment, or discrimination based on HIV status. 16 Finally, funders are not the only stakeholders to whom CBMHIs are accountable. Previous studies have highlighted the lack of time for and logistical difficulties faced in establishing collaborations and engaging different types of stakeholders, such as policy makers, implementation partners, service providers, people with lived experience and communities themselves. 13 Active stakeholder engagement is crucial for participation in knowledge transfer, dissemination of work, increased service uptake, policy change and promoting long-term adoption and sustainability of activities. 13 17 18 To address these challenges, the SHM Foundation, a UK-registered charitable foundation, and the Mental Health Innovation Network (MHIN), a collaboration between the London School of Hygiene and Tropical Medicine and the World Health Organization (WHO), initiated the Ember Mental Health programme ('Ember') in 2019 (box 1). Ember supports CBMHIs in low-resource settings to sustain, grow or replicate their work. Over the cours
Keywords Extracted from PMC Text: people individuals' SHM 2018–2019 settings27 health.1 2 rat Midline South-to-North contacts line people's partnerships.21 strategies.6 funding.14 London School of Hygiene Enabled South-to-South activities.11 donors human priorities.7 13 £ COVID-19 CBMHIs York.28 's funds bodies L6 processes,6 7 US$ L4 settings.26 27 participants etc),3–5 — low- health networks
Extracted PMC Text Content in Record: First 5000 Characters:The social and economic systems and structures that affect people's everyday lives play an important role in shaping their mental health.1 2 While structural responses are needed (eg, poverty reduction strategies, policies ensuring the human rights of vulnerable populations are protected, etc),3–5 community-based mental health initiatives (CBMHIs) also play an essential role in supporting local populations to identify and address risk factors, promote mental health and well-being and strengthen systems of care through specialised support.6 CBMHIs are well positioned to understand the needs and priorities within their local contexts and are uniquely equipped to respond with relevant, culturally sensitive and sustainable strategies.6 However, these initiatives face significant challenges, including insecure, restrictive funding often tied to burdensome administrative processes,6 7 limited organisational capacity—including capacity to apply for competitive funding calls—and difficulties demonstrating impact or disseminating their work to and engaging with stakeholders. Indeed, across all funding sources, resources allocated to mental health are low. Median government expenditure dedicated to mental health ranges from just US$0.02 per capita in low-income countries to US$2.62 in upper middle-income countries.8 Further, available government funding does not always make its way into communities. In low- and middle-income countries, over 80% of mental health spending goes towards psychiatric hospitals typically located in urban areas,8 and many district-level health planners lack any budget line for mental health.9 Funding by global actors is also scarce. By 2017, only 0.4% of international development assistance for health was allocated to mental health (US$132 million)10—this may have decreased recently due to cuts in official development assistance from high-income countries and diversion to COVID-19 response activities.11 Mental health also receives the lowest proportion (0.5%) of philanthropic development assistance compared with other health conditions.12 Where funding is available, it may be granted for only short periods of time or with restrictions on when and how it can be spent, that make it difficult for CBMHIs to remain responsive to local needs and priorities.7 13 Demonstrating impact is another resource-intensive task that is not always adequately costed and supported by funders, even when it is required as a condition of funding.14 Showing how and to what extent initiatives are impacting the mental health of their communities is essential to service development and improvement—yet it requires technical expertise within teams that may not always be available. Further, the field of global mental health has traditionally focused on clinical and functional outcomes to measure impact.15 However, these metrics are not always the most directly relevant or feasible for CBMHIs addressing contextual issues or systemic vulnerabilities to improve mental health, such as access to employment, or discrimination based on HIV status.16 Finally, funders are not the only stakeholders to whom CBMHIs are accountable. Previous studies have highlighted the lack of time for and logistical difficulties faced in establishing collaborations and engaging different types of stakeholders, such as policy makers, implementation partners, service providers, people with lived experience and communities themselves.13 Active stakeholder engagement is crucial for participation in knowledge transfer, dissemination of work, increased service uptake, policy change and promoting long-term adoption and sustainability of activities.13 17 18 To address these challenges, the SHM Foundation, a UK-registered charitable foundation, and the Mental Health Innovation Network (MHIN), a collaboration between the London School of Hygiene and Tropical Medicine and the World Health Organization (WHO), initiated the Ember Mental Health programme ('Ember') in 2019 (box 1). Ember supports CBMHIs in low-resource settings to sustain, grow or replicate their work. Over the course of a 12-month partnership, Ember works with initiatives in areas such as accessing funding, expanding their networks or building skills to demonstrate impact, communicate with stakeholders or develop business plans. Here we describe key learning from the 2020–2021 Ember programme and recommendations for funders and other stakeholders interested in supporting implementers in global mental health. Ember's approach to community-based mental healthcare is based on: (a) contextual specificity; (b) interdisciplinarity and coproduction of knowledge; and (c) sustainability over scale. Accordingly, Ember forms partnerships with CBMHIs addressing the needs of local communities in culturally relevant ways that want support to sustain, grow or replicate their work. Support is provided as needed in the areas described in figure 1. Ember has a multidisciplinary team with skill sets in research, im
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