CHaRISMA (Curtailing Hospital Readmission In people with Severe Mental illness in Africa)

点击翻译按钮获取中文摘要

While serious mental illness (SMI) defined as schizophrenia, bipolar disorder, or psychosis is only 0.06% of global mental illness, those suffering from SMI in low income countries do not have access to reliable and well accepted community based treatment, where they could get the support and care of family and local community. People with SMI in Uganda can be treated in the national mental hospital and be given medication. But once their condition has been stabilised, and they are ready to leave hospital, even if their family are prepared to have them back home, there are no government agencies to counsel, care and follow up their recovery needs. There are simply few resources available and little international attention and research has focused on this area. Addressing this important gap is the focus of this research. The Preventing Hospital Re-admissions for People with Severe Mental Illness in East Africa (PRISM) development project has been designed in partnership with the Ugandan NGO YouBelongHOME (YBH), who have begun an innovative programme working to improve appropriate, hospital to home mental health interventions with human rights values at the core. Butabika Mental Health Hospital, Kampala, Uganda are partners in this work. YBH is delivered by a multi-disciplinary team. Due to extremely scarce resources, sustainability can only occur by empowering families and local communities, to provide a basic level of support and care, and by re-creating the national mental hospital as short term acute care to stabilise people with severe mental illness and to return them to community care as soon as possible. YBH is centred on post hospital discharge interventions to empower the family as an active agent in the returned person's recovery, and also, to connect to family, friends and communities. Recovery is supported through discussions and dialogue with family and discharged person regarding health, housing security, family income, medication needs, knowledge of mental illness/ myths, how to assist in the recovery process, reinforcing particular tribal values to give impetus to supportive behaviour, developing problem solving skills, ways to give and receive respect and recognition. Despite its potential, the YBH intervention lacks systematically gathered evidence for its effectiveness in East African LICs. Before conducting a larger clinical trial which aims to establish this evidence, more information is needed to determine the feasibility, acceptability, and appropriateness of the YBH intervention in settings like Uganda. To gather this information PRISM will explore 3 areas. 1) Explore who is at risk of mental health hospital readmission in Uganda within 3 months of discharge and develop a risk score as a tool for health workers; 2) Using action research and patient and family interviews, test and refine the YBH pre- and post-discharge intervention with a sub-set of patients and families in Kampala and Wakiso districts, the principal catchment area for Butabika Hospital. What could be improved and how? 3) Undertake a feasibility assessment of community-based initiatives using qualitative data collection and a Delphi Method as a means of involving a range of people with different perspectives sharing their expertise, and coming to a consensus about best options. There are many options (e.g. community development at village and family level; rapid or emergency response team and micro-financing initiatives, peer support workers). Which might work best and against what criteria?The research findings will inform the design of a future clinical trial which has a primary outcome to decrease readmission within three months of discharge among high-risk patients with SMI in East African countries, and better support people discharged from hospital recover at home.