The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65562

Joy Noel Baumgartner, MSSW, Department of Maternal & Child Health, University of North Carolina-Chapel Hill, PO Box 314, Bynum, NC 27228, (919) 542-1001, baumgart@email.unc.edu and Sylvia Kaaya, MD, Department of Psychiatry, Muhimbili University College of Health Sciences, PO Box 65023, Dar es Salaam, Tanzania.

Mental disorders will account for 15% of the global burden of disease by 2020, yet psychiatric morbidity has not received proportionate attention, particularly in sub-Saharan Africa. Prevalence estimates of psychotic disorders in Tanzania compared to utilization rates of government psychiatric services suggest that only a fraction of adults with psychotic disorders access public services for treatment. The purpose of this study is to describe the current public mental health system in Dar es Salaam, Tanzania and the patient population utilizing these services, and to assess which factors hinder or facilitate accessing these services. Methods: Eight months of participant-observation with patients and families during ward rounds, acute admissions and outpatient clinics at the Department of Psychiatry, Muhimbili National Hospital; key informant interviews with 20 mental health providers in Dar es Salaam including doctors, nurses, and social workers; and a review of psychiatric facility statistics. Results: Families manage relatives with psychosis at home for as long as possible seeking help from extended family, traditional healers and religious leaders prior to accessing psychiatric clinics. Limited services and poor quality of mental health care often discourage service utilization. Lack of education about mental illness and availability of services by both patients and non-mental health providers further contributes to a lack of referrals and weak coordination for community-based follow-up care. Recommendations: Plans to strengthen and expand existing services should include a public campaign to raise awareness of symptoms and available treatment and continuing mental health education in primary care clinics to facilitate the referral system.

Learning Objectives:

• • Describe and discuss the strengths and weaknesses of the public mental health system in Dar es Salaam, Tanzania.
  • Articulate adaptive coping strategies that families use to care for a relative with mental illness in the community.
  • Identify key factors that either hinder or facilitate access and utilization of psychiatric services at the individual, familial and community level.

Keywords: Mental Health Services, International Health

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.