FPD Mental Health System Strengthening Projects

Our work in South Africa

  • FPD, has since 2019, in partnership with NDoH and all Provincial DoHs with sponsorship from Sanofi been implementing a limited MH system strengthening project focusing on building MH treatment and referral capacity at PHC level. FPD has trained 1120 PHC nurses and doctors in diagnosing and managing non-complex MH issues to improve referrals for complex MH issues to regional and tertiary psychiatric centres. This initial project has continued in 2021 with the additional training of 500 Mental Health practitioners, all the training being conducted virtually in view of the COVID restrictions. The focus in this training was on compliance with the Mental Healthcare Act and the roles and responsibilities of all in the quality care chain to ensure that mental health users are receiving the care they need.

  • The initial MH project has culminated in a journal publication in the African Primary Healthcare Family Medicine Journal (PHCFM) available at the Digital Object Identifier: https://doi.org/10.4102/phcfm.v13i1.2909

  • During the COVID-19 pandemic FPD soon realised the effect of the lockdown restrictions and concomitant demands on patient care, in the wake of high morbidity and mortality rates on the mental health and well-being of healthcare workers and the general public. Two online courses to build mental resilience were developed within a short period of time; the first focussed on the general public with content embracing the importance of healthy lifestyles, exercise, creative activities and the role of routines during lockdown to keep mentally sane. In the second course the focus was on healthcare workers and how to support them in staying mentally strong and stable – the course provided insights into anxiety and depression and how to overcome them with available helplines and support structures and gave direction should depression and Post-traumatic stress become a reality. Many organisations have supported their employees and healthcare workers by making this course available through sponsorships – this amounted to more than 6000 participants accessing this course.

  • South Africa is making progress towards ending the HIV epidemic with a 50% decline in AIDS deaths in the past decade. Efforts are now focussing on making progress towards achieving global HIV 2025 targets of 95% of PLHIV knowing their status, 95% of those diagnosed being on therapy and 95% of those on therapy being viral suppressed. To achieve these targets, the healthcare system must mitigate factors that negatively impacts on AIDS epidemic control including the impact of stigma, mental health issues, violence and substance abuse. Mental health disorders are also associated with reduced PrEP, HIV testing, treatment uptake, retention in care and poor viral load suppression. The Coronavirus pandemic has had a detrimental impact on mental health across all populations with increases in anxiety, depression, PTSD, substance use, and suicide being reported. The pandemic has had also significantly impacted on the MH of HCWs. Ensuring a more resilient and healthier workforce will in turn support more compassionate, destigmatizing service provision, leading to improved patient outcomes

  • Proposed activities will focus on two main areas namely: i) supporting the integration of mental health support activities into existing HIV/TB prevention and treatment programs and ii) supporting HCWs to increase their own awareness of their mental health, access self-help solutions and facilitate access to professional care. The technical approach will be implemented through five work streams designed to ensure achievement of the period of performance outcomes:
    • Technical Assistance. Our highly skilled team has extensive experience in MH and HIV/TB program management and providing technical assistance to government. Our technical advice will target all stakeholders (community, facility, implementing partners and government) to assist in evidence-based mental health service delivery, supervision and improved performance. of effort.
    • Training FPD, working with Columbia University Psychiatry Department, will offer a wide range of accredited courses (online, virtual and in-class formats) customized to the requirements of HCWs • Mentoring activities are designed to improve the capacity of individuals and organizations to provide improved MH services. Our model combines mentorship, coaching and on-the-job training to effect sustainable changes in professional practice. Various digital health solutions will also support mentoring.
    • Mentoring activities are designed to improve the capacity of individuals and organizations to provide improved MH services. Our model combines mentorship, coaching and on-the-job training to effect sustainable changes in professional practice. Various digital health solutions will also support mentoring.
    • Community Engagement & Information Education and Communication (CE& IEC) uses evidence-based stakeholder engagement approaches to secure buy in and support for public health interventions and information, communication and education (ICE) campaigns. ICE campaigns will be designed to create awareness of MH issues, decrease stigma and increase service uptake.
    • Digital Health: The project will have a strong focus on leveraging digital technology to provide an integrated digital mental health solutions, including the Vula Mobile app, a referral and mentoring application; an Electronic Mental Wellness Tool (E-mwTool), developed by Columbia University that supports HCWs to apply validated screening tools, and then provide, according to need, Screening, Brief Intervention, and Referral to Treatment (SBIRT-MI), Interpersonal Counselling (IPC), and Safety Planning Interventions; and Lynx-HCF is a mobile health platform that includes a patient mobile app, electronic medical record, telemedicine module and mental health care plans.

  • The Consortium includes three leading indigenous South African organizations supported by Columbia University Department of Psychiatry a leader in global mental health. FPD (www.foundation.co.za) is a leading health educator in Africa that has trained more than 500 000 HCWs and managers across 45 countries in Africa with extensive PEPFAR implementation experience. Vula Mobile, is an award-winning technology solution that allows virtual consultation and referral within the public sector in South Africa. This technology already connects 18,003 health workers, across 6,002 health facilities and 53 specialties. Heartlines, is a leader in behavioural communication and community engagement.

Our work in Africa

  • FPD in partnership with Columbia University: FPD has been partnering with Columbia University since May 2017 to implement an NIH/NIMH funded program titled PRIDE SSA - Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence Based Practices in sub-Saharan Africa. This program has established a collaborative network of mental health (MH) stakeholders (researchers, teaching faculty, service providers, and policy makers) in five Sub-Saharan countries (Botswana, Malawi, Mozambique, South Africa, Zambia). The project builds capacity through implementation research focused on scaling up community mental health care integrated within public health services based on the mhGAP Intervention Guide developed by WHO. PRIDE SSA has to date achieved the following: i) conducted rigorous scale-up research in partnership with policy makers to identify and implement the best task-sharing delivery pathway for sustainable trans-diagnostic community MH services, integrated into the public health system in Mozambique, including deployment of MH screening and treatment applications; ii) trained and supervised over 200 clinic-based mental health care providers to offer Screening, Brief Intervention, and Referral to Treatment (SBIRT-MI) and Safety Planning Interventions ; iii) established a multidisciplinary MH research network in all five countries comprising researchers, faculty, policy makers, and trainers of trainers; iv) provided Policy TA on the use of MH research to inform policy and program development and v) implemented a Trainer of Trainers program in Mozambique to develop MTs.

Creating a mental resilient workforce programme:

The Coronavirus pandemic has had a detrimental impact on the MH of employees. A recent McKinsey & Company global survey showed that 62% of employees consider MH issues to be a top workplace challenge but only 16% indicated that management was providing the required support [1].

The neglect of MH in the workplace is also wasteful. According to WHO, depression and anxiety costs the global economy $ 11 trillion/annum and a $1 investment in workplace MH progammes translates into $4 in increased productivity. If unaddressed the risk of a negative organizational collective mental health problem developing increases rapidly, therefore; from an organizational perspective, developing a mentally resilient workforce has become a strategic imperative for organizations.

FPD has reflected on its experience of delivering the first Mental Health selfcare course for HCPs at the end of 2020. The demand for the course rapidly exceeded the available sponsorship due to very unprecedented uptake. FPD has a programme to develop a mentally resilient workforce to maintain a high level of productivity within the new normal that is evolving in response to the Coronavirus pandemic.

The proposed technical approach uses an integrated technology solution to provide an organisation and their employees with customized tools and learning interventions designed to build mental health resilience support programmes across three pillars:

  • Awareness
  • Prevention
  • Self-care /self-help