mHealth for Mental Health Program
Low and Middle Income Countries
Digital Health: West Africa
West Africa faces enormous mental health challenges,
including lack of sufficient mental health professionals and
clinical infrastructure, limited access to medication, and
pervasive societal stigma around mental illness. People with
mental illness often go undiagnosed, untreated, or chained
and confined for weeks, months or years at a time in prayer
camps.
Locally, no one advocates for the continuation of abusive
practices; stakeholders from all sectors including
government, academia, commerce, and healthcare are
concerned about human rights violations. Religious leaders,
traditional healers, and those who operate prayer camps
that engage in these controversial practices have expressed openness and willingness to explore more humane approaches. They need alternative tools.
Our group has deep partnerships with researchers, mental health advocates, clinicians, traditional and faith leaders, and people with lived experience of mental illness in West Africa. Together, we collaborate to develop digital health approaches to combat stigma, support humane care, and improve mental health outcomes using blended interventions (e.g., Evidence-Based Psychosocial AND Spiritual; Technological AND Pharmacological; Mental Health Professional AND Paraprofessional/Caregiver).
A Digital Toolkit (M-Healer) to Improve Mental Health Care
Working in close collaboration with researchers at the University of Ghana, our team developed a digital toolkit designed to train traditional and faith healers to deliver brief psychosocial interventions to people with mental illness while also discontinuing their use of practices that may constitute human rights violations. Following a series of prayer camp visits and observations, individual interviews, focus groups, and co-design sessions with healers and prayer camp staff, we produced M-Healer. Once the prototype was developed, a usability study was conducted with faith healers in Ghana who found the tool to be feasible, acceptable, and usable. Read more here.
Combining mHealth and Nurse-Delivered Mental Health Care
In West Africa, most people suffering from serious mental illnesses like schizophrenia and bipolar disorder receive care from traditional and faith healers in “prayer camps.” Specialized mental health providers are scarce in the region, yet the prevalence of traditional healers and clustering of individuals with serious mental illness within the prayer camps offer opportunities to deliver evidence-based treatment to this population. Professors Dror Ben-Zeev at the University of Washington and Angela Ofori-Atta at the University of Ghana are co-leading a multinational team of researchers investigating a two-level intervention package involving a mobile health program which trains healers to deliver high-quality mental health interventions (M-Healer), and visiting mobile nurses who deliver medications directly to patients at prayer camps. With funding support from the National Institute of Mental Health (Grant # R01MH127531-01A1), we are evaluating the effectiveness of this intervention in multiple prayer camps throughout the region. Read more about this study here.
WADMA: Building Capacity for Digital Mental Health Research in West Africa
Developing and supporting a new generation of digital mental health leaders and innovators in West Africa is vital to improving mental health in the region. Our group at the University of Washington is collaborating with leaders in Ghana and Nigeria to establish the West African Digital Mental Health Alliance (WADMA) – a regional mission-centered network of early-career researchers and trainees with a particular interest in improving mental health through digital interventions. Through WADMA, members will build their network and receive targeted career development in digital mental health research alongside like-minded professionals. WADMA is the first cross-institutional initiative advancing capacity in digital mental health research in the region. Read more about WADMA here.
Responding to Adolescent Perinatal Depression with Patient-Centered Mobile Health in West Africa
Many factors influence the accessibility of health care facilities by perinatal adolescents. Adolescence has distinct developmental challenges, along with self-stigma (i.e., shame relating to getting pregnant at a young age) and public stigma from health care providers and others in the community that can make accessing these services difficult. Effective, flexible, and convenient-to-access interventions are needed to address the health care needs of pregnant adolescents.
Led by Dr. Lola Kola, this project will build on previous work to scale up efforts for perinatal depression for adolescents in primary care in Nigeria. Dr. Kola will lead efforts utilizing user-centered design (UCD) principles to develop a mobile phone application to complement a face-to-face intervention for perinatal adolescents within routine care. Elements from the WHO mhGAP Evidenced-based Guidelines for Management of Perinatal Depression will be adapted for this work.
Digital Health for Early Psychosis in Ghana
The most substantial declines in functioning among people with psychotic disorders occurs
during the first five years of illness, called “early psychosis”. This period is particularly vital
for engaging young adults experiencing early psychosis in treatment services. In West Africa.
the hardships of early psychosis are compounded by pervasive societal stigma, scarce
treatment options, and systematic exclusion and neglect. Innovative approaches are needed
to fill gaps in mental health services to improve care for those impacted by early psychosis –
patients and their family members.
Our team at University of Washington and Accra Psychiatric Hospital conducted a mixed
methods needs assessment among multiple stakeholder groups (patients, caregivers, and
clinicians) which helped us understand:1) the mental health and psychosocial support needs
of people experiencing early psychosis in Ghana, 2) technology use and readiness of people
impacted by early psychosis in Ghana (early psychosis patients and their caregivers/family
members), and 3) capacity to use technology to support in-patient and outpatient early
psychosis care. We found that 1) people often face barriers to care due to stigma, lack of
proper psychoeducation, and cost, 2) strong rapport and trust with clinicians can motivate
people to seek care, and 3) patients commonly use technology in their daily lives,
indicating feasibility for digital tools for mental health. Read more about our needs assessment
here. Our findings have informed the development of digital tools for provision of evidence-based psychosocial interventions
that support early psychosis patients and their families in West Africa. Learn more about how our findings are informing future directions in early psychosis support here.
Sexual Trauma in West Africa
Sexual violence against vulnerable populations is common worldwide. Many survivors of sexual assault experience long-term mental health difficulties. This
study evaluated sexual violence exposure among women with mental illness in Ghana and examined their readiness to engage in mobile health interventions. We surveyed 200 women receiving inpatient or outpatient treatment at a large psychiatric hospital. Survey results indicated that 41.0 % reported having experienced sexual violence in the past. Over two-thirds of respondents had a high probability of PTSD (68.4 %) and these proportions were higher among those who experienced sexual violence (77.5 %). The majority were interested in mobile health resources that could provide them with support (73.2 %). Respondents' top topics of interest were information about managing stress and improving mood. The skill they were most interested in was relaxation. Video and audio content were rated as preferred intervention modalities. Most of the sample reported owning a mobile phone (86.4 %), with most being smartphones (76.1 %). Almost all respondents reported having access to electricity (99.5 %), a majority had a data plan (86.2 %), and all reported daily mobile phone use (100.0 %). Our findings suggest that there are significant unmet mental health needs among female survivors of sexual violence who are already receiving care in Ghana; most female survivors of sexual assault are open to using mobile health interventions; and most women with mental illness have access to the resources necessary for deployment of mobile interventions in their communities. Smartphone applications that leverage video and audio content may be particularly suitable for this context. Read more about our work here.
