The South African Depression and Anxiety Support Group (DASG) is in the process of implementing a powerful educational program developed by the World Health Organisation (WHO) to assist primary health care workers in the diagnosis and treatment of common mental disorders. The program targets the mental disorders of depression, anxiety, alcohol abuse, social phobia and sleep disorders.
The WHO program has been prepared as a flexible set that can be tailored to different settings. It is brief, clinician-friendly, management-oriented and applicable to a variety of different cultures and settings. It also provides state-of-the-art reference and information materials to increase awareness of mental disorders and improve their treatment.
Research has shown that up to 24% of patients who present themselves to primary care workers suffer from a well-defined mental disorder. Unfortunately, many of these cases remain undetected. Thus the WHO has decided to develop this educational program which can act as a practical tool to improve the knowledge, skills and behavior of health care workers.
In the South African setting, the program is being piloted in Mpumalanga. The DASG is focusing on the illnesses of depression and panic disorder first. Thereafter, social phobia and PostTraumatic Stress Disorder (PTSD) will be targeted. The educational program is being sponsored by a grant from Synthelabo.
In implementing the WHO program, the DASG will be making use of their three dimensional approach which has worked so well in the past. The first step in the approach involves the expertise of the DASG’s outreach co-ordinator, Therry Nhlapo who sets up a workshop for a psychiatrist to interface with all General Practitioners
(And other health-care professionals), social workers, teachers and police in the vicinity of the targeted community. Once the medical professionals have been made aware of the initiative, the next step in the process occurs with the educational program being practically implemented. Ex-sufferers are encouraged to help open regional support groups in the area. These support groups empower sufferers by easing the stigma of mental illnesses and giving sufferers a collective “voice” so that they are able to campaign for their rights.
The final step in the process involves re-assessing the programs after a period of 3-6 months has passed. It is important to maintain regular monitoring of the progress and functioning of the programs in the various communities. Questionnaires are also filled out by health professionals in order to assess the effectiveness of the techniques.
The WHO program consists of a number of practical tools for the health care worker to make use of. These include questionnaires, “handycards” (summarised important information about particular disorders), brochures and diagnostic tools. Health care workers should first conduct a brief mental health assessment of patients by using the screening questionnaires and the checklist that is supplied in the WHO program. During the interview with the patient, the health worker should be aware of vague or evasive responses to questions. If it appears that the patient does have an identified disorder, then the health worker can use the appropriate “handycards” interactively to explain the disorder and determine a treatment plan for the patient. It is also useful to provide a self-help leaflet – which are being locally supplied by the DASG – and set up follow up vists with the patient.
In the case of the patient presenting with multiple disorders, it is best to treat the alcoholic problems first, whilst any depressive illness should take priority over anxiety disorders.
Finally, if a patient seems to be bordering on a disorder in that he/she has given many positive responses to the questions but not enough for a diagnosis, then the health worker should still use the “handycards” interactively with the patient. The health worker should also be available for further consultation should the need arise.
The DASG was the first support group to take the initiative and infiltrate disadvantaged and rural communities through education and support programs. The group is the largest private initiative in South Africa with over 75 active regional support groups countrywide – 28 if which have been specifically created for previously disadvantaged communities.
Mrs Nhlapo believes that the educational program is already having a significant impact on South African community health: “This project is the best thing to happen to Mpumalanga where the resources are so scarce, and there is only one psychiatrist in private practice for the entire area. The zest with which people offer to start off self-help groups after workshops on the WHO educational program shows that this has been a long-awaited community project."