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Breaking the cycle of poor mental health

28 March 2024

Following the COVID-19 pandemic, concern was raised over increases in demand for mental health services, exposing chronic inadequacies in global provision. 

WHO brief in 2022 estimated a 25 to 27 percent increase in the prevalence of depression and anxiety as a result of the pandemic.

With the additional impact of ongoing political and economic uncertainties, and society feeling more polarised than ever, it is apparent that even well-resourced national healthcare systems are struggling to meet the emotional health needs of their country’s population. This has led to a call from the WHO to make mental health and wellbeing a global priority.

Healthcare inequality, access to information and education and socioeconomic disparities, inevitably mean that it is the world’s most vulnerable communities who will face the greatest impact of poor mental health. People affected by neglected tropical diseases, such as leprosy, face perhaps some of the greatest challenges in maintaining their mental health, which is widely understood to have a direct effect on people’s physical recovery. According to a mental health and NTD study published in Leprosy Review, one in two people diagnosed with leprosy experiences depression and/or anxiety.

*An image taken at the project orientation workshop, at the start of the project. In total 20 participants including; Mental Motivators, Federation leaders and project staff participated in the workshop. The workshop was facilitated by Project Manager, PO-MEL and the Head of HR & Admin from the Dhaka Country Office. Photo credit: Md. Rafiqul Islam, DCO

Operational Research

Recognising the important role of positive mental health for people affected by leprosy, over the last decade, Lepra have developed a series of operational research projects, which seek to integrate emotional health strengthening components, into leprosy and lymphatic filariasis (LF)  treatment programme design. One such example is the Mind 2 Heart project in Bangladesh, which is now moving into its second phase.

Building on learning gained from projects such as Lepra’s ‘Mental Motivators’, the Mind 2 Heart project is a community-led research project, funded by the Sasakawa Health Foundation, and working in partnership with the Bogura Federation – a grassroots Community-Based Organisation (CBO) supported by Lepra, which brings together a network of 101 community ‘self-support groups’ throughout Bangladesh’s Bogura District.

Running throughout 2023, the first phase of the project aimed to support 300 people affected by leprosy with grade 2 disability in the Bogura District. Mind 2 Heart’s initial aims included lowering levels of anxiety and depression alongside raising awareness. Improving access to community and specialist mental health services was key along with widening the capabilities of the Federation to serve as a centre of holistic care.

To help improve mental healthcare access, alongside the project’s physical and socioeconomic care aims, three tiers of intervention were made available: With community volunteer ‘Mental Motivators’ trained to provide lower-level support, awareness raising and signposting, professional structured counselling for people with moderate need, and specialist onward referrals made for the highest level of mental health needs. 

Phase 1 activities, including mental health counselling, were well received by participants. With 91% of survey participants stating that Mental Motivator support has been beneficial for their mental wellbeing and 73.7% stating that they had better knowledge about mental health issues.

Therapeutic Interventions

The second phase of the project, began in the Spring of 2024, seeks to implement improvements from lessons learnt during the first phase of the project. In particular, the need for more intensive and longer-term therapeutic interventions for supporting people with moderate mental health needs, and greater capacity for the team of Mental Motivators to provide lower-level emotional health support, information, and a point-of-contact for the community. As Mind 2 Heart continues, the solid foundations provided by phase one, will allow the project to further strengthen the ability of the Federation to provide even more effective holistic care for the communities they represent.

The Mind 2 Heart project demonstrates that there is no single intervention which can solve the issue of poor mental health. It is clear that a range of interventions are needed, the interdependency of emotional, social, financial, and physical health for people affected by leprosy is clearer than ever, and Mind 2 Heart will continue to be embedded into local healthcare structures, with the Federation leading sustainable improvements for years to come.

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