This study aims to determine the burden of mental illness (especially depression) among persons affected by leprosy or BU, and whether community-oriented approach improves their mental health and well-being.
Improving mental health and quality of life of persons affected by leprosy or Buruli ulcer in Southern Nigeria
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Project summary
Leprosy and Buruli ulcer (BU) co-exist in many States across Nigeria. Both are diseases of public health importance and are often associated with high levels of stigma and discrimination owing to their tendency to cause visible deformities. In 2018, Nigeria reported 2095 and 424 as number of persons suffering from leprosy and BU respectively. The number of persons disabled as a result of these diseases is unknown but it is estimated to be over thirty thousand.
Over time, stigma and discrimination negatively impact the well-being and mental health of persons with these diseases, resulting especially in depression or anxiety. Mental health services in Nigeria suffer from multiple gaps. It is estimated that there is only one mental health expert for hundreds of thousands of inhabitants. The few available professionals are disproportionately based in urban areas, leaving the millions of rural dwellers grossly underserved. This is especially so for the poor and marginalized like many leprosy and BU sufferers. This is compounded by poor funding of the health sector by the federal government. In 2017 and 2018, budgetary allocations to health were 4.16% and 3.9% respectively. There is need to explore sustainable ways to make mental health services accessible to those in dire need, especially persons affected by leprosy and BU.
Some studies show that a community-oriented approach run by trained lay persons (without specialist mental health background) with appropriate supervision, can improve access to effective, acceptable and cost-effective mental health services.
This project has a dual objective: 1) to determine the burden/extent of mental illness (especially depression) among persons affected by leprosy or BU 2) and ascertain whether a holistic (multi-layered) community-oriented approach involving patient self-help groups, lay community counsellors and non-specialist health workers improves the mental health and well-being of leprosy/BU patients in southern Nigeria.
It is believed that the use of self-help groups (SHG), lay community counsellors and trained health workers will reinforce and complement each other in a synergistic manner, resulting in outcomes superior to approaches based on health workers alone.
During the 4-year project period, ten local government areas with highest number of leprosy/BU patients in southern Nigeria were selected. Advocacy visits to relevant groups will precede training of lay community counsellors to provide counselling for patients identified to have depression or anxiety and promote social participation. Self-help groups will be established to provide enabling platform for peer-support through regular interactions/meetings, reduce self-stigma and promote self-esteem among patients. Trained health workers will ensure effective treatment and/or adequate referral services for patients. At the end of project, patients will be re-assessed to determine any difference in their mental health status and quality of life.