Community mental health model in Nigeria

Children’s mental well-being plays a key role in their development, and it is significantly affected by that of parents or caregivers. Community mental health care models can be integrated into family strengthening programs and train helpers in the community to provide mental health support. In Nigeria, SOS Children’s Villages has begun to use the Problem Management + intervention, seeing positive outcomes.

Problem Management + (PM+) is a mental health intervention targeting people aged 16 or older who are affected by any form of adversity and are experiencing some level of distress. PM+ aims at decreasing early symptoms of mental health issues such as depression and anxiety when there is not yet a need to see a specialist. Certified trainers train helpers in the community to use PM+.

Helpers are frontline workers who directly work with families. Since June 2021, 25 members of SOS Children’s Villages staff in Nigeria have been trained as PM+ helpers.

“For adult members of families within our family strengthening program, the PM+ intervention is quite useful to ensure psychological issues do not deteriorate into full-scale mental health issues, which can lead to the caregiver’s inability to provide adequate care and protection for the children as well as to child-family separation,” says Oluwole Amosu, Programme Development Advisor at SOS Children’s Villages in Nigeria.

Problem Management + develops over five weekly sessions, supporting people through the use of evidence-based techniques such as problem solving, stress management and accessing social support.

Mental Health Discussions

The trained helpers guide program participants through the sessions so they find out for themselves the source of their emotional and practical issues. The focus is then on what the clients themselves can do and change.

According to Amosu, “PM+ allows clients to identify their problems. We guide them to identify what options they have. This way, they come up with solutions within their circle of influence and control. We enable them to get out of their problems themselves and to take the lead to create change.”

Stigma, shame and cultural beliefs that attribute mental health issues and remain a major barrier to addressing mental health issues. Community models which do not require families to seek the help of a psychologist can help reduce stigma.

SOS Programme Development Advisor-Gender Nandi Dakum observes that language barriers and a general lack of awareness of the importance of mental well-being also pose challenges.

“You do not have to go and see a specialist; instead, the trained helpers in the community provide the non-specialized service. This is a huge step for us to make the intervention accessible, use it widely in family strengthening programs and extend it to other people in the community who are not part of our programs,” says Dakum.

“After the community awareness, clients usually come with basic knowledge on what the PM+ intervention is about and are open to going through particular issues,” adds Nandi Dakum.

Due to the COVID-19 pandemic, meeting and training helpers in person were often not possible. In some situations, PM+ intervention sessions were held virtually, while remote training of certified PM+ helpers and trainers also proved to be effective in spreading the service.

In 2020, mental health and psychosocial support experts of SOS Children’s Villages adapted Problem Management +, originally developed by the World Health Organization (WHO), for remote use in collaboration with the International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support and the New School for Social Research (NSSR) in New York City.

As a result of the collaboration, helpers were trained in Belgium, Burundi, Ethiopia, Greece, Italy, Nigeria, Rwanda, Somalia, Somaliland, South Africa, Sweden, Uganda and the United States.

The training of helpers comprised a wide range of learning modalities, including lectures, demonstrations, role play and group discussions using tools such as Zoom, Mural, Google Drive and WhatsApp. Role-play activities during Zoom meetings, for example, allowed participants to practice and receive live feedback on their newly gained skills.

In Nigeria, it has only been several months since PM+ became part of family strengthening programs, but responses and increased reach indicate positive outcomes for families’ well-being, the care and protection of children and efforts to keep families together.

“Almost everywhere in the world, people will focus more on their physical health than their mental health. It should be an imperative that in family strengthening we focus just as much on mental health and psychosocial support,” concludes Oluwole Amosu.