Health Works publishes new papers on community mental health
In 2017, Health Works has been working with other scholars on three research projects, all evolving around the same subject – mental health. The studies investigate different topics of mental health, but all provide findings that can be used to improve interventions that focus on treatment or at least increase the capacity to cope with psychosocial and mental problems.
The first study explores the relationship between the changed context where an individual lives in due to a flood- for example characteristics of neighborhood - and the influence of the changed social structures in the neighborhood has on a process that defines and individual’s mental health. The belief is that socio-ecological interventions, as a specific type of community interventions, address both the causal links between the individual process that determines one’s mental health, and the social context one lives in. However, there is no empirical evidence that social context directly affects the individual’s mental health. These research results show that there are differences between men and women how and which context mechanisms have different effects on the individual processes involved in their mental health. The findings of this study can be used to optimize and increase the impact of interventions to improve mental health and psycho social well-being of individuals and their community by taking into account the different effects of gender inequity on both the individual and contextual level.
The second study examines one of the major mental health disorders in Nepal: depression and alcohol use disorder and the barriers to initiation and continuation of mental health treatment. Most individuals coping with these mental health problems do not have access to or do not use mental health services. In case treatment was sought or started, individuals show very low commitment to continue their treatment. The survey shows that the major reported barriers to treatment were (1) lacking financial means to afford care, (2) fear of being perceived as ‘weak’ for having mental health problems, (3) fear of being perceived as ‘crazy’ and (4) being too unwell to ask for help. Barriers to receive treatment did not differ based on demographic characteristics such as age, sex, marital status, or education.
Finally, the third study investigates the underutilization of mental health services, as one of the major barriers for reducing the burden of disease associated with mental, neurological and substance-use disorders. Health Works developed earlier a community informant detection tool to detect people with mental disorders. These people were most of the time not identified by the existing primary care-based screening tools. With this innovative tool community members were identified and referred who normally do not visit health-care facilities or who lack access to these services. This study looks at the effect of the community tool on the help-seeking behavior of individuals identified by this tool, and whether they received any treatment.More than 67% out of the 509 people identified through the community tool accessed health services and 77% of those individuals that look for services initiated mental health treatment. The findings of this study show that this innovative tool increased the utilization of mental health services in a low-income country with few health resources.
 Wind, T.R. and I.H. Komproe (2017). Closing the gap between disaster mental health research and practice: evidence for socio-ecological mental health interventions through multilevel research. Intervention, 15, 3, 1-13.
 Luitel NP, Jordans MJD, Kohrt BA, Rathod SD, Komproe IH (2017) Treatment gap and barriers for mental health care: A cross-sectional community survey in Nepal. PLoS ONE 12(8): e0183223. https://doi.org/10.1371/journal.pone.0183223
 Jordans, M.J.D., Kohrt, B.A., Luitel, N.P., Lund, C., Komproe, I.H. (2017). Proactive community case-finding to facilitate treatment seeking for mental disorders, Nepal. Bulletin of the World Health Organisation; 95(7):531-536.