Community-based Mental Health Services Can Out-Perform Traditional Services – WHO Guidance
A lay counsellor on the Friendship Bench in Zimbabwe

Some community-based mental health services can outperform traditional services – and are cheaper, and often more rights-based – according to a new guidance released this week by the World Health Organization (WHO).

The guidance provides two-dozen peer-reviewed examples of outstanding community-based mental health projects – including the Friendship Bench in Zimbabwe, Atmiyata in India, and a survivors’ group in Kenya.

Using “person-centered” and “rights-based approaches” to care yielded outcomes that were far better in terms of reducing people’s dependence on psychiatric drugs and easing their full reintegration into communities, the study found. 

In addition, the trained peer- and lay-workers and day community centers are also cost-effective in comparison to expensive hospitalizations. 

Stories of Success Featured at Launch Event    

Stories from Kenya, India, the United Kingdom and elsewhere were among the case studies featured in the report – and shared in a global launch attended by over 4,000 people.  

Speakers at the event, including Dr Michelle Funk, development lead of the guidance, and WHO Assistant Director-General Dr Ren Minghui, who underlined how mental health care and service delivery demands profound change in the face of poor-quality care and human rights violations. 

“Our hope is that the WHO guidance will bring urgency to policymakers around the globe to invest in community-based mental health services and give hope to better lives for the millions of people with mental health conditions and their families worldwide,” said Minghui.  

The report provides real-world examples of good practices in mental health services in diverse contexts worldwide and describes how services need to be linked to housing, education, employment and social protection sectors.  

The report will also be used to support countries in their effort to align mental health care and service delivery with international human rights standards, such as the Convention on the Rights of Persons with Disabilities (CRPD). 

India: Volunteers Have Experience With Mental Health Problems

Dr Soumitra Pathare, Director, Centre for Mental Health Law and Policy, Indian Law Society, India

Many volunteers of the India-based Atmiyata community volunteer service were motivated to join the program as a result of their own experiences with distress, promoting and championing community inclusion. 

“People who will bring about the change are going to be people with lived experience of mental health,” said Dr Soumitra Pathare, Director of the Centre for Mental Health Law and Policy at the Indian Law Society, who works with Atmiyata.

Atmiyata identifies and supports people experiencing distress in rural communities of the Gujarat state in western India.

Volunteers raise awareness in the community about mental health issues, identify people experiencing distress and provide up to six sessions of counselling. They also refer people who may have severe mental health conditions to the public mental health service and to support people in need with access to social care benefits.

In addition, Pathare emphasized that the change in mental health service will not come from technology, but from people, making it important that these programs utilize the voice of affected communities: “We need to tap into the social capital that exists in our communities.” 

Kenya: Peer-support Restoring Power, Voice and Choice

Michael Njenga, CEO of Users and Survivors of Psychiatry, Kenya

The Users and Survivors of Psychiatry in Kenya (USP-K) promotes and advocates for the rights of persons with psychosocial disabilities through peer support groups for its members and training on self-advocacy and human rights. 

“[The value of peer-support groups] has been about restoring power, voice, and choice to persons with psychosocial disabilities,” said USP-K CEO Michael Njenga.

“Peer support is built on the premise of recovery and recovery in itself recognizes and acknowledges a person’s abilities and doesn’t focus so much on the disability,” added Charlene Sunkel, Founder and CEO of Global Mental Health Peer Network.

The group supports people to become autonomous in their decision-making and day-to-day lives by helping people think through and make decisions about their employment situation, living arrangements and health care and treatment. 

Members of USP-K have been trained on the Convention on the Rights of Persons with Disabilities and the Sustainable Development Goals, which have been the bedrock of the program, said Njenga, adding that USP-K has also been exploring alternative ways of addressing distress beyond the biomedical model. 

“This has been important in shaping the narrative towards meaningful inclusion of peer-support groups in different areas of their lives – access to government opportunities, both mainstream and disability-specific, and participation in policy and legislative reforms.” 

At the core of this, said Njenga, is the organization’s effort to support economic empowerment programs, access to social protection programs, and strengthening of support systems, which is an important aspect of living independently and being included in the community. 

“This has brought an important shift of seeing inclusion beyond the lens of mental health.” 

Zimbabwe: Problem-Solving Through Peer-Support and Community Inclusion

Zimbabwe’s Friendship Bench, derived from a Shona term which means, “bench to sit on to exchange ideas,” provides short-term problem-solving therapy for people with common mental health conditions. 

Given the scarcity of mental health services in Zimbabwe, the Friendship Bench fills an important gap and need for community mental health service provision.  

The service is delivered by lay health workers – mostly older women, who are seen as important guardians of the community and are therefore respected. 

Friendship Bench clients also can join a peer-support group, Holding Hands Together, where people can share experiences in a safe space. 

Such support groups bring people with lived experience together in a sense of solidarity, as participants support each other and create opportunities for joint problem-solving.  

Addressing Poverty, Education, Housing and Employment are Key to Mental Health 

Panelists also advocated for significant changes in the social sector, such as access to education, employment, housing, and social benefits for people with mental health conditions and psychosocial disabilities. 

“Social determinants are equally as important in mental health outcomes,” said Executive Director of Nigeria-based She Writes Woman Hauwa Ojeifo. 

Added Dr Soumitra Pathare, “Poverty and mental health go together. You cannot address mental health without addressing the issue of poverty. 

Many services featured in the guidance do attempt to address the social determinants of health. For instance, KeyRing Networks in the United Kingdom provides time-limited independent but supported living arrangements for people experiencing mental health conditions. 

Housing is either rented from local authorities or housing associations or owned by members. Each network ensures that KeyRing members take control and responsibility for their lives by living in a place of their own and contributing and being connected to their local community.

Bringing Human Rights to Mental Health During the COVID-19 Pandemic 

Panelists highlighted the importance of the guidance as the COVID-19 pandemic has had a serious detrimental impact on mental health. 

“The WHO guidance comes at the right time, in a moment when we are witnessing the devastating impact of the pandemic on the mental health of our communities and in particular, populations at risk,” said Costa Rican UN Ambassador Catalina Devandas.

Gerard Quinn, the UN Special Rapporteur on the Rights of Persons with Disabilities, said:  “The question we now ask is not what limits are placed on rights and how they can be policed. The question we now ask is how we can give life to rights.” 



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