Advancing multisectoral and life-course approaches in mental health research
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Date
2023
Journal ISSN
Volume Title
Publisher
Academy of Science of South Africa (ASSAf); Academy of Medical Sciences (AMS)
Sponsorship
UK Academy of Medical Sciences (AMS); Janssen Pharmaceutica (Pty) Ltd
Abstract
Although there is some evidence of increasing investment, mental health
services are a neglected aspect of healthcare in sub-Saharan Africa.*
However, the COVID-19 pandemic – and control measures associated with it
– has shone the spotlight on mental health challenges and their human,
social and economic costs.
The impact of the pandemic has highlighted the importance of the biopsychosocial model of mental
health, which recognises that mental wellbeing is affected by the interplay between ‘internal’ biological and
psychological factors and ‘external’ social, political, and environmental influences. For the latter, the social
determinants of mental health concept highlights how a wide range of external factors across several
domains have a critical impact on mental wellbeing. Interventions targeting social determinants or structural
factors have the advantage of potentially delivering benefits to large numbers for prolonged periods.
In November 2022, the UK Academy of Medical Sciences and the Academy of Sciences of South Africa
jointly organised a workshop to explore ways to advance multisectoral and life-course approaches in mental
health research in sub-Saharan Africa.
In breakout groups, workshop participants discussed successful examples of mental health research in
sub-Saharan Africa, similarities and differences across countries, and how greater collaboration could
advance multisectoral and life-course approaches to mental health research. These discussions highlighted
a range of key themes:
• Strengthening and diversifying data sources: Participants suggested that, in some settings,
additional data are needed on disease burdens, priority populations and social determinants of mental
health which could be used to support advocacy, target action and guide the development of new
interventions. As well as epidemiological data, long-term longitudinal data could provide insights into
pathways to mental health impact and identify potential points of intervention.
• Developing consistent, locally defined, standardised and appropriate metrics for valued
outcomes: Delegates stressed the importance of consistency in approaches across studies, and use of
contextually validated and standardised measures, to ensure quality and facilitate comparisons and data
pooling. These measures need to be culturally relevant and meaningful to people with lived experience,
capturing broader social and economic outcomes alongside clinical improvement. It is also important
to capture qualitative as well as quantitative inputs through these metrics. To promote a life-course
perspective, measures need to be suitable for use beyond the traditional focus on working-age adults.
• Promoting translational development: The need for additional research across the translational
spectrum was highlighted, including more evaluation of ‘grass-roots’ initiatives, additional confirmatory
and larger-scale studies following promising pilot studies, and implementation/operational research
to accelerate introduction and scale-up of evidence-based policies and interventions. It was argued
that interventions should prioritise integration with existing health system and community platforms,
and adopt people-centred approaches.
• Strengthening partnerships to achieve the above: Participants identified interdisciplinary and
multisectoral collaborations as critical to progress, potentially supported by an integrated conceptual
framework to facilitate cross-sectoral interdisciplinary research programmes and intervention development.
Strengthened collaboration within the region and internationally, through equitable international
partnerships with a commitment to capacity-building, was seen as fundamental. Participants also stressed
the need for a systems-based approach and engagement with all relevant actors, including members
of the public, the informal health sector (such as traditional and faith healers) and the private sector
where appropriate.
• Building relationships with people with lived experience to ensure input at all stages:
Delegates highlighted the critical importance of engaging with people with lived experience, to provide
opportunities for meaningful inputs at all stages of research, including prioritisation of research
questions and co-creation and delivery of interventions.
• Optimising the mental healthcare workforce: Strengthening and building workforce capacity in
mental health were seen as high priorities. Mental health specialists are few in number in the region
and further research on strategies such as task-shifting, and scaling up of proven task-shifting interventions,
could help to address large treatment gaps. Participants also suggested that there is a need to promote
skills development to support greater service and multi-sectoral integration, task shifting, and mental
health awareness across relevant sectors.
• Supporting advocacy to promote the above: Delegates identified the need for the research
community to engage with policymakers to understand their needs and provide evidence-based inputs,
to leverage the mainstream media to translate messages for more general audiences, and to work with
people with lived experience to achieve co-ordinated and more effective advocacy.
By strengthening ties – within Africa and internationally – the mental health research community in the
region will be better placed to share knowledge and experience, develop joint and multicentre studies,
and raise the profile of mental health research among politicians and policymakers. In doing so, they can
help to close the mental health care gap and build a field with the capacity to enhance mental health for all
and at all stages of life.
Description
10 pages
DOI
Citation
Peer review status
Non-Peer Reviewed