I walked the walk with Dr Tedros Developing Ethiopia’s Mental Health Strategy By Dr Tedla

A Road Map for Treatment and Prevention of Depression and Other Psychiatric Disorders

By Dr Tedla W. Giorgis, Executive Director, Visions for Development, Inc.; Senior Advisor, Ministry of Health, Federal Democratic Republic of Ethiopia; Former Director of Multicultural Services Division, District of Columbia Department of Mental Health, USA.

Last week, World Health Day marked the culmination of a yearlong campaign focused on depression. According to the World Health Organization (WHO), over 300 million people worldwide suffer from depression, making it a leading cause of disability.

In the predominantly rural country of Ethiopia, mental illness comprises 11% of the total burden of disease out-ranking HIV/AIDS. Community surveys in Ethiopia have consistently shown that severe mental illness, for example resulting from schizophrenia or bipolar disorder, as needing intervention.

In December 2010, I was inspired by Dr Tedros Adhanom, then Minister of Health, to come to Ethiopia to support the development and implementation of Ethiopia’s National Mental Health Strategy. At the time, I was working as the Director of the District of Columbia’s Department of Mental Health Multicultural Services Division, where I had been for 28 years.

(Dr. Tedros visiting clinics in Ethiopia.)

Since I was trained in the U.S. as a clinical psychologist, Dr Tedros thought I could help bring focus to those who are suffering in silence from depression and other forms of mental disorders in Ethiopia.

His instruction to me was very simple and succinct, to make sure that that the strategy was (a) developed with extensive input from a wide range of stakeholders, (b) integrated in Ethiopia’s setting and primary health care delivery system (especially in the Health Extension Program), (c) costed and sustainable with institutionalized local funding, and (d) supported by those who will play a critical role in its implementation.

Otherwise, Dr Tedros warned me: “the strategy will wind up on a shelf accumulating dust.” Moreover, he said, “my office door will be open for consultation and support, take your time and do it right.”

Recognizing the need for gaining political commitment for the first time a ministerial Mental Health Technical Working Group was formed. This group guided the development of the strategy and various fora were organized to share this strategy, pulling in key stakeholders.

These activities were planned to ensure buy-in and commitment during the implementation phase. Dr Tedros once told me: “without buy-in and ownership by the community and by stakeholders — even if the strategy is elegant — implementation will be impossible.”

Unfortunately, depression is not well recognized within Ethiopian communities and is often explained away as a result of psychosocial problems, e.g. marital problems or poverty. As such, we realized activities in Ethiopia’s National Mental Health Strategy needed to include creating awareness and lessening of stigma, engagement of the faith-based organizations as partners, scaling of services in hospitals and health centers by training staff and ensuring the availability of selected psychotropic medications.

I am proud of the key accomplishments since the development and implementation of the strategy:

1. The budget for mental health scale up, including training and procurement of psychotropic medications, has been institutionalized with local funding.

2. Major hospitals have established outpatient services and inpatient short-term emergency psychiatric stabilization beds, ranging from 10 to 35 beds per hospital. Additionally, two long-term psychiatric hospitals have been built with a capacity to treat over 300 patients.

3. A National Institute on Mental Health has been established to direct all mental health related activities and a 6 story building is currently being built to house the institution

4. In FY 2010, Ethiopia was one of the first six countries selected by WHO as a demonstration pilot site for the implementation of mental health Gap Action Programme (mhGAP). This resulted in the integration and scale up of mental health services in over 200 health centers.

5. For the past five years, Ethiopia has also been a member of 6 consortium countries participating in a UKAID-funded Programme for Improving Mental Health care (PRIME) and EC-funded EMERALD projects. These are providing valuable information on the ‘how to’ to scale up and deliver effective mental health care in primary health care settings.

I learned the main ingredient for this successful program for mental health was political commitment, and for this reason I am profoundly grateful to Dr Tedros for his vision and for the opportunity to make such a difference.

You can read more about Dr Tedros and his vision for a healthy world as #NextDG at his website: http://www.drtedros.com/ — and follow along with his campaign on social media at Facebook.com/DrTedros.Official and on Twitter at @DrTedros. Sign up for the campaign’s newsletter `From the Desk of Dr. Tedros’ at http://bit.ly/2nGWtLm. #WALKEDTHEWALK