Thematic working group 4: Decentralization of mental health care

  • Moderator: Ms Hilde ButtiĆ«ns
  • Speakers:
    • Mr Jean Luc Nkengurutse (Burundi)
    • Ms Jeanine Kamana (Burundi)
  • Discussant: Ms Elvire Sosohounto (Benin)

In this session, we will look at mental health projects created as a result of local initiatives. We will question the limits to be set to the creativity of communities and international actors in this field: to what extent can the provision of specific care – for example, trauma clinics, support for victims of sexual violence, child psychiatry, etc. – be encouraged in response to local needs? How much should support to the creativity of local actors be balanced with the need to guarantee a certain homogeneity of supply at the national level as well as quality standards? For example, what role should the health ministry take regarding the involvement of non-specialists in the socio-therapeutic offer? Should a limit be set to their interventions? There is a consensus in the international literature on the conditions under which, in low- and middle-income countries, locally-provided mental and psychosocial health care (preventive care and follow-up, social reintegration, etc.) can be effective and easily accessible. These conditions are the following: this care should be anchored in the community and provided by adequately trained actors. To what extent are these conditions met in the field? To what extent are they considered relevant by local actors?

Depending on the time available, we will also look at the concrete ways in which mental health care provision can be linked to the whole range of (medical, social) services available locally. Do certain forms of information sharing between stakeholders, consultation and coordination of interventions prove more effective than others? How do patients and their families react? Is there a craze for these new forms of care or, on the contrary, is there a reserve, a cautionary note which could be a hindrance?

The speakers and participants will contribute to our thinking by indicating how these questions were answered in their respective countries/projects.