4 - (SYM 61) Combining Mhealth and Nurse-delivered Care to Improve the Outcomes of People with Serious Mental Illness in West Africa: The M-healer Project

Serious mental illnesses (SMI) contribute to disability globally, particularly in low- and middle-income countries (LMICs) where mental health services are disproportionately scarce. In West Africa, < 1 mental health professionals exist per 100,000 people. This treatment gap leads most people with SMI in West Africa to seek services from traditional healers, which are more prevalent. In Ghana there are >130 traditional healers per 100,000 people. Healers lack evidence-based approaches to treat SMI. Practices can include chaining, seclusion, and forced fasting that worsen negative impacts of SMI. The dearth of skilled mental health providers combined with the relative abundance of healers and their associated infrastructures (e.g., referral networks, “prayer camps”, community ties) highlight the potential to leverage well-attended healer settings, supported by appropriate training and resources, to provide higher-quality care for people with SMI in Ghana. Ghana’s advanced telecommunications infrastructure offers opportunities for digital interventions to expand access to mental health services (Ben-Zeev, 2018).  

Our multinational research team developed M-Healer–a mobile health program designed to train healers to deliver evidence-based psychosocial interventions while maintaining safety and patient dignity in practice. We will present key insights from co-developing M-Healer with healers and demonstrate M-Healer functionality. Findings from s usability, acceptability, feasibility, and preliminary clinical testing (Ben-Zeev et al., 2021) will also be shared. Collaborators from University of Washington, University of Ghana, and Basic Needs–Ghana are now evaluating M-Healer in a dual-pronged intervention, combining M-Healer with pharmacotherapy delivered directly to patients via visiting nurses. We will discuss experiences forming this collaboration and implementing a stepped wedge randomized cluster trial in 18 prayer camps in Ghana comparing psychiatric symptoms among prayer camp clients with SMI during enhanced usual care (psychoeducation for healers) versus M-Healer plus nurse-delivered pharmacotherapy.