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

虽然严重精神疾病（SMI）被定义为精神分裂症，双相情感障碍或精神病仅占全球精神疾病的0.06%，但低收入国家的严重精神疾病患者无法获得可靠和广泛接受的社区治疗，在那里他们可以得到家庭和当地社区的支持和照顾。在乌干达，重度精神障碍患者可以在国家精神病院接受治疗，并获得药物治疗。但是，一旦他们的病情稳定下来，他们准备出院，即使他们的家人准备让他们回家，也没有政府机构来咨询、照顾和跟进他们的康复需求。可利用的资源很少，国际上对这一领域的关注和研究也很少。解决这一重大差距是本研究的重点。与乌干达非政府组织YouBelongHOME（YBH）合作设计了东非预防严重精神疾病患者再次入院发展项目，该组织已开始实施一项创新方案，努力改善以人权价值观为核心的适当的从医院到家庭的心理健康干预措施。乌干达坎帕拉的Butabika精神健康医院是这项工作的合作伙伴。YBH由一个多学科团队提供。由于资源极其稀缺，只有赋予家庭和当地社区权力，提供基本的支持和护理，并重建国家精神病院，作为短期急性护理，以稳定严重精神疾病患者的病情，并尽快将他们送回社区护理，才能实现可持续性。青年波黑中心的重点是出院后干预，以增强家庭作为返回者康复的积极因素的能力，并与家人、朋友和社区建立联系。通过与家人和出院者就健康、住房安全、家庭收入、药物需求、精神疾病/神话知识、如何协助恢复过程、加强特定部落价值观以推动支持性行为、发展解决问题的技能、给予和接受尊重和认可的方式进行讨论和对话，支持恢复。尽管YBH干预措施具有潜力，但缺乏系统收集的证据证明其在东非低收入国家的有效性。在进行旨在建立这一证据的更大规模的临床试验之前，需要更多的信息来确定YBH干预在乌干达等环境中的可行性，可接受性和适当性。为了收集这些信息，PRISM将探索3个领域。1)探索谁是在出院后3个月内在乌干达精神卫生医院再入院的风险，并制定一个风险评分作为卫生工作者的工具; 2）使用行动研究和病人和家庭访谈，测试和完善YBH出院前和出院后的干预与坎帕拉和Wakiso地区的病人和家庭的子集，Butabika医院的主要集水区。哪些方面可以改进，如何改进？3)利用定性数据收集和德尔菲法对社区倡议进行可行性评估，使具有不同观点的各种人分享他们的专门知识，并就最佳选择达成共识。有许多选择（例如，村庄和家庭一级的社区发展;快速或紧急反应小组和小额供资倡议、同伴支助工作者）。哪一个可能最好，根据什么标准？研究结果将为未来临床试验的设计提供信息，该临床试验的主要结果是减少东非国家高风险SMI患者出院后三个月内的再入院率，并更好地支持出院患者在家中康复。

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.