Co-production and piloting of socio-culturally embedded systems strengthening interventions to improve quality of care for people with mental health conditions in Somaliland (CopilotS).

Background

Mental health conditions (MHCs) are highly prevalent in Somaliland, while services to treat them are frequently of low quality and rarely provide respectful, rights-based care. Due to this and a high level of stigma, many people with MHCs choose not to use any form of care – either public or faith-based – resulting in many people with MHCs remaining untreated at home.

Our goal is to understand the reasons people with MHCs choose the care they do and the experiences they have, providing information we can use to intervene to improve the services provided. Research summary and timeline

Our work is based on a sequential process, and later aspects build on earlier ones. This sequence maps on to our Work Packages (WPs).

1. Adapt and implement activities to equip and support people with MHCs, their caregivers and health workers to increase their empowerment and build foundations for participation in research, advocacy and co-production of an intervention package (months 1-12)

2. Understand perspectives on care-seeking for specific MHCs and quality of mental healthcare among this group of participants (months 1-12)

3. Facilitate a Theory of Change (ToC) process to understand prioritised outcomes for people with MHCs and their caregivers and map the steps to achieving these outcomes (stage 1, months 13-15, stage 2, months 35-36)

4. Co-develop (months 16-24) and pilot (months 25-34) an intervention to improve the ability of faith-based, specialist and general healthcare services to provide beneficial and respectful care to people with MHCs. Aim

Our overall aim is to intervene to improve the quality of mental health care provided in public and faith-based sectors such that people with MHCs have the option to seek care in either sector that is respectful and ensures their human rights are protected. Methods

We will empower people with MHCs, caregivers and health workers to participate in research design using Participatory Action Research-informed method future workshops (WP1). WP2 will involve semi-structured interviews and focus groups alongside ethnographic observation of encounters in care facilities in both the public and faith-based sectors. We will then conduct a ToC process followed by development of a ToC map (WP3).

We will use this map to develop a package of interventions, guided by the MRC ADAPT framework for complex interventions. The interventions will then be piloted and evaluated using process evaluation. The pilot will be followed by a final ToC meeting to produce a final ToC map. Anticipated outputs and impact

We anticipate that our greatest impacts will be to:

1. Empower people with MHCs and their caregivers so they have the skills and knowledge to proactively shape the direction of future mental health research in Somaliland 2. Improve understanding of and respect for MHCs among health workers to increase respectful, rights-based care

3. Identify the major issues people with MHCs and their caregivers experience in accessing and using mental healthcare and intervene to address these issues. Dissemination

Within Somaliland, we will build on existing relationships with officials in the Ministry of Health Development through regular sharing of study progress, research findings and building strategy for wider implementation. Broader dissemination will be via peer-reviewed publications and conferences and through WHO collaborating centres and the Centre for Global Mental Health.