October 2009 December 2011
“I ran into many cases of mental disorders during my consultations, but I ignored how to behave. The training courses filled this gap and allowed me to take care of my patients in a better way.”
NINA DOSSA, nurse in the health zone of Ouidah
In Benin, as in other developing countries, more than 75% of those affected by mental disorders do not receive any kind of care nor do they have access to pharmaceutical treatment.
The financial resources allocated by Benin’s Ministry of Health to mental health amount to 0.25% of the public health budget, and are mostly used in running the psychiatric facilities in the city of Cotonou. As a result, the availability of mental health services in the country is extremely limited and is concentrated in the financial capital of the country.
The human resources in the mental health sector are insufficient to meet the needs of the population. Benin has only got one public mental health hospital and, according to the official registry, only 13 psychiatrists in the entire country. In addition, there is no professional school for psychiatric nurses.
The stigma linked to mental disorders and the traditional beliefs concerning depression or psychoses are widespread in Benin, including among health care workers.
In this environment of lack of public resources and absence of social awareness, thousands of individuals are marginalized, completely isolated or cast out.
The project aims at reinforcing the mental health system in Benin with the objective of increasing access to care, thus enhancing the living conditions of people with mental disorders in many regions of the country.
To reach this goal, mental health services will be integrated into primary health care.
The two main reasons why doctors and nurses at primary care level normally eschew people with mental illnesses are insufficient training in mental health care and old superstitions. Hence, the mental health care system is to be upgraded to improve the living conditions of those affected by mental disorders.
Said integration will promote accessibility and affordability of treatment, will enable early diagnosis and prevent forced institutionalization of patients. Mental health patients will be treated at the primary level of care in a holistic manner, addressing both their physical and mental health needs.
Saint Camille de Lellis Foundation.
Mental Health National Program of Benin.
Ministry of Health of the Republic of Benin.
Using the Health Gap Action Program’s Intervention Guide’s (mhGAP-IG), the training program covered the priority conditions, as well as other disorders relevant to the local population, of the three pilot health zones. During the first two years, the training consisted of six one-week sessions.
The first year focused mainly on health care workers. Comparison between results from the pre- and post-training exams showed a general improvement in the competencies they acquired. The training sessions improved the professionals’ ability to diagnose and treat patients, as well as make referrals to specialists where and when needed.
During the second year, the training program focused on nurses and midwives. Since there are many more health attendants in health centers and hospitals than there are doctors, nurses and midwives were trained and allowed to examine patients and, in most cases, also prescribe medicines.
Several trainees admitted being skeptical about the project at the beginning, mainly considering mental health to be the jurisdiction of psychiatrists and traditional healers. Now, these health providers have recognized the importance of proper mental health treatment and are efficiently operating in their communities.
The stigma regarding mental illness that was present among participants has been practically eradicated.
The number of health centers providing mental health care in the pilot zones increased to 44, all due to the success of the training sessions. The number of direct beneficiaries is now estimated to be 500,000, which is quite a feat with a total population of 8,700,000.
The inclusion of several mental disorders in the national information system’s list of diseases was another of the project’s important triumphs. The system collects official data on a national scale, which is used to plan and manage health policies at peripheral and intermediate levels. When the project started, the system did not include any mental disorders.
The facts and figures collected during the program in the pilot zones were used to show Benin’s Ministry of Health the extreme need for additional mental health services the country is in.