Research from the World Health Organization (WHO) has found that more than 500 million people worldwide suffer from mental health disorders, costing the global economy more than $1 trillion in U.S. dollars annually in lost productivity. Of those people, a full 70% of those in need of mental health services lack access to care.
In Africa these statistics can be even worse due to a variety of factors including a widespread stigma held by many against those suffering from mental illness, mistaken beliefs that mental health cannot be treated, and a lack of resources for treating it. African leaders often prioritize other challenges over mental health as they tackle issues ranging from poverty to infectious diseases to conflicts. In Africa most countries devote an average of less than 1% of their health spending to the problem, compared with 6% to 12% in Western countries.
Dr. Theddeus Iheanacho, assistant professor of psychiatry at Yale, is working to help change that.
In 2018, Iheanacho partnered with a group of other researchers to kickstart the HAPPINESS Project (Health Action for Psychiatric Problems In Nigeria including Epilepsy and Substances), a pioneering program based in Imo State, Nigeria, that aims to increase access to effective, evidence-based treatments for mental disorders and epilepsy in underserved areas of the country, using technology and existing care infrastructure.
In Nigeria, there is one psychiatrist for every 4.8 million people. To overcome this lack of capacity the HAPPINESS Project brings together mental health specialists, educators, implementation experts, and administrators from a broad swath of cross-cutting partner organizations to integrate mental health care and treatment into general medical care in Nigeria.
The program oversees the training of primary care workers in rural communities to screen for, assess, and manage mental disorders in their communities. It was originally initiated as a collaboration between Yale’s Department of Psychiatry, Yale’s School of Medicine, and Imo State University’s Teaching Hospital, and is supported by the Yale Global Mental Health Program, CBM International, the Imo State Primary Health Care Development Agency, and Imo State Government.
“Currently, people living in Imo State must travel four to six hours by road to see a psychiatrist. As such, those needing mental health services typically don’t make the trip. The HAPPINESS Project changes this, bringing mental health treatment closer to where people actually live,” said Iheanacho. It trains non-mental health specialists — such as primary care physicians, nurses, and community health care workers — how to provide mental health treatment in primary and secondary health care centers, all under the supervision of professional psychiatrists.
“It is sad to see young persons who are vagrant because of their inability to access care close to where they live,” said Dr. Chinyere Aguocha, a consulting psychiatrist and clinical supervisor for the HAPPINESS Project. “HAPPINESS Project provides care to patients close to their homes; providing effective treatment to mentally ill people who may otherwise end up living on the streets.”
To date 37 primary care workers from 13 primary care centers have completed HAPPINESS Project initial and refresher trainings. Within its first three months the HAPPINESS Project teams enrolled over 50 patients who otherwise would not get any care. Plans are underway to train an additional 88 primary care workers in 2019 to reach more primary care in the state.
“My dream has always been to bring mental health care to everyone needing it across Nigeria and to the South East in particular,” said Dr. Emeka Nwefoh, mental health advisor, CBM International, and one of the key HAPPINESS Project program administrators. “This project has provided a platform for me to start the process of actualizing this dream. A dream to have mental health care accessible with only a five-minute walk from the home of everyone needing care in Nigeria.”
Iheanacho says a short-term goal is to implement the HAPPINESS Project in all primary care centers in Imo State. In doing so, project team members will develop standardized project manuals, training protocols and processes, and a framework for sustained access to medication and support in the community.
“This worthy project provides a vehicle for addressing a critical, foundational element of wellness often completely ignored and derided by the Nigerian society,” said Dr. Charles Dike, associate professor of psychiatry at Yale University School of Medicine and one of the researchers who designed the HAPPINESS Project.
Iheanacho and his team are also piloting a HAPPINESS Project telemedicine framework at two sites in Imo State. This framework will connect primary care clinics to the specialists at the tertiary centers, reducing the need for long travel hours. Iheanacho is also working with the Department of Biomedical Bioengineering to develop a training app that will reduce the need for in-person training and enhance training for remote centers.
“Our intent is to use telemedicine and mobile technology tools to increase access to Nigerian psychiatrists at home and in the diaspora through their participation in the HAPPINESS Project,” said Iheanacho. “If all goes well, it could be adapted and serve as a model for integrating mental health in primary care not only in Nigeria, but eventually many other African countries.”