Mental Health and Psychosocial Support Programme

HealthNet TPO works in 14 out of 17 provinces in Burundi, a buildup that has been gradual. A substantial part of the mental health and psychosocial support activities is carried out with Dutch government funding. Some evaluation remarks on relevance of the programme:

• The programme addresses the vulnerability of the Burundian people due to trauma and distress, associated with the long period of violence, ongoing insecurity and destruction of the social tissue. But also relevant irrespective of the war, as mental disorders, epilepsy psychosocial problems are also prevalent in other populations. The users of services have problems that are not necessarily related to collective trauma, insecurity, violence or even poverty. Epilepsy is the major problem presented to the psychosocial counsellor as well as to the mental health nurses. Though the aftermath of war may aggravate the problems.
• The programme is very relevant also in the context of the health systems reforms in Burundi which emphasize decentralisation and performance based financing and the integration of mental health care in primary health care services. The continued funding through the Dutch Ministry of Foreign affairs should carry this forward.
• It is equally relevant for the development of a social welfare and psychosocial assistance policy which needs to address the mending of the social tissue of Burundi. Psychosocial assistance that may need to focus more on empowering and less on charity, more on development and less on humanitarian aid.

The programme has gone through four phases, including a pilot phase. Each phase resulted in the integration of mental health and psychosocial support services in more and more provinces:

Pilot phase: 2000-2001

 First phase: 2001-2004 

Second phase: 2005-2007 
In the second phase of the programme, direct services of psychosocial assistants were reduced in the western provinces and certain responsibilities were taken over by trained community volunteers. Also a training programme for psychosocial assistants of the Ministry of Solidarity was conducted in two Northern provinces of Muyinga and Kirundo. Three new provinces in the south were added, where psychosocial support counsellors were trained and psychosocial activities were established. The approach of the mental health component was two pronged:

• Awareness for community mental health interventions was raised through workshops on mental disorders and treatment possibilities (like individual and family counselling and – when necessary - referral of people with mental problems, group therapeutic sessions and sport & recreational activities for the youth).
• Decentralization of mental health care services including training of government nurses and the organisation of monthly mobile mental health clinics in a number of provincial hospitals. Essential psychotropic drugs were provided by the programme as well as all necessary equipment and materials. In provinces not covered by HealthNet TPO the psychiatric hospital of Kamenge organized monthly mobile clinics and support with essential drugs.

Third phase: 2007-2008  (see the right column)
While psychosocial assistance in the three Western provinces was fully integrated into the services of community volunteers, in the Northern provinces of Kirundo and Muyinga the psychosocial assistance was integrated into services of the Ministry of National Solidarity (implemented by their psychosocial assistants working with the centres for Family Development (CDF) with supervision of HealthNet TPO). In the Southern provinces of Bururi, Makamba and Rutana psychosocial assistants were mobilizing community volunteers to take over the direct service delivery. The Ministry of National Solidarity took over psychosocial care in the province of Rutana.

This delegation to more community based structures consisted of training, ‘on the job coaching’ and supportive supervision by experienced psychosocial counsellors of HealthNet TPO. Psychiatric care was decentralized and integrated into primary health care services of the provincial hospitals in the provinces of Kirundo, Muyinga and Gitega as static clinics. HealthNet TPO has continued to provide technical assistance, supervision, psychotropic drugs and follow up of monitoring system. Mental health clinics are functioning in Ruyigi, Cankuzo, Kayanza, Muramvya, Bubanza and Cibitoke.

Fourth phase: 2008
Mental health services have been integrated into the primary health care in the provinces of Kirundo, Muyinga, Gitega, Makamba, Rutana, Karuzi and Bururi and lately also in Mwaro and Cankuzo province.

Recent activities: 2009-2011
During this period HealthNet TPO has maintained the programme following the successful period from 2000 to 2008. However this has taken place in a more project focused manner. The general programme building on the previous phases has been carried out emphasizing the following results:

• Relevant psychosocial services are delivered through empowered community key figures;
• Capacity of authorities in psychosocial policy and strategy development is strengthened;
• Key messages, best practices and lessons learned are documented and disseminated for (policy) advocacy purposes;
• This programme then addresses key community figures sensitizing them in psychosocial care using the previous experience in communities and identifying gaps in knowledge and need. It also continues to train health staff in health facilities and improving integration into primary health care.

In summary, the system of identification and management of people with mental health disorders within the health care system is improving through the collaboration between community structures and health facilities. But the next big step is to continue with mental health integration until district level and continue training of health centres in mental health diagnosis and strengthen referral systems to the hospital. Therefore continuous efforts need to be made to strengthen the collaboration between communities, health centers and hospitals.

In 2010, an estimated 35,000 community members of both local associations and international organizations received training in psychosocial awareness and service delivery, while 1,500 people were trained to provide psychosocial care. As a result, local associations, structures and authorities now have adequate capacity to develop their own programmes and provide psychosocial support.