Piloting Mental Health First Aid in Uganda: Lessons Learned

Overview: Research suggests that there is a high prevalence of mental disorder among post-war Ugandans. This study describes the lessons learned from piloting Mental Health First Aid, a standardized evidence-based early intervention model, with churches throughout Uganda. Considerations for cultural adaptations of EBPs will be discussed.Proposal text: Between 1986 and 2006, northern Uganda suffered from civil unrest claiming an estimated 63,826-99,941 civilian lives. Unable to stop the violence, in 1996, the Ugandan government, required the Acholi people of northern Uganda leave their villages and take residency in government-run camps for internally displaced persons (IDPs). An estimated 400,000 Acholi people were left homeless, while 1.7 million people lived in these IDP camps across the region at the height of the conflict (Amone-P’Olak, Ovuga, Croudace, Jones, & Abbott, 2014).
Research suggests that there is a high prevalence of mental disorder, including post-traumatic stress disorder (PTSD) among post-war Ugandans (Vinck, Pham, Stover, & Weinstein, 2007). One study reported 35.5 % of Ugandan study participants had experiencing high traumatic events during their childhood and 23.0 % indicated coming from families with psychiatric disorder history. Although the prevalence of mental problems in this population is high there are few formal mental health treatment options for Ugandans. Individuals are more likely to talk to pastors in times of distress than mental health professionals. However, beyond providing prayer and scriptural based encouragement, pastors/clergy are limited in their responses to individuals experiencing mental and emotional problems. Pastors and clergy in Uganda are in need of psychoeducation and practical tools to address the number of mental health problems present among their congregants and community members.
Mental Health First Aid
Mental Health First Aid is an evidenced based intervention designed to provide individuals, like pastors, with basic knowledge and skills to identify and address mental health concerns. This is an 8-hour course, facilitated by a certified trainer, and teaches individuals how to identify, understand and respond to signs of mental illnesses and substance use disorders. Just as CPR training helps a person with no clinical training assist an individual following a heart attack, Mental Health First Aid training helps a person assist someone experiencing a mental health crisis such as contemplating suicide. Mental Health First Aiders learn a single 5-step strategy that includes assessing risk, respectfully listening to and supporting the individual in crisis, and identifying appropriate professional help and other supports. Participants are also introduced to risk factors and warning signs for mental health or substance use problems, engage in experiential activities that build understanding of the impact of illness on individuals and families, and learn about evidence-supported treatment and self-help strategies. This intervention has been implemented and tested in countries around the world and various cultural contexts.
This current study sought to pilot test MHFA in Christian church members and leaders in Uganda. Because of the high prevalence of mental problems and lack of access to professional mental health treatment among Ugandans MHFA was believed to be an appropriate intervention to provide community based support to those experiencing mental and emotional problems. This study revealed several considerations when implementing evidenced based interventions in developing nations. Challenges with country infrastructure, technology access, participant literacy, and cultural perceptions of mental illness are discussed.