Background

There is a growing need for mental health and psychosocial support (MHPSS) interventions that can feasibly be provided to larger groups of people, particularly in humanitarian settings. However, scaling up mental health interventions is notoriously difficult. There are therefore growing calls for integrating mental health outside traditional health structures, both to increase reach and to address social determinants of mental health. The objective of this study is to explore barriers and facilitators of Self-Help Plus (SH+), an MHPSS innovation implemented through multisectoral integration. We explore delivery and uptake at the scale of SH+ and aim to understand intervention adaptation needs when integrating SH+ within other health and non-health sectors in Uganda.

Method

We conducted a qualitative study using in-depth interviews in two phases: first for a needs and resource assessment, and second for a process evaluation. We conducted 50 in-depth interviews with BRAC Uganda and MoH partner staff, intervention facilitators, and target impact group members between July and December 2022. A thematic network analysis process was used to identify barriers and facilitators of SH+ delivery and uptake at scale in Uganda.

Results

We identified five major factors that should be considered when scaling through multisectoral integration, namely: (1) adaptivity, (2) funding mechanisms, (3) social capital, (4) participation, and (5) sustainability. Within these factors, there were varying degrees to which a factor was a facilitator or barrier, depending on participants’ perceptions of the intervention.

Conclusions

Our findings suggest that multisectoral integration of SH+ into sectors both inside and outside of health may be a viable means to scale SH+ and increase reach. However, funding, partnerships, co-creation, and adaptability need to be further explored to facilitate better and more sustainable integration.

Plain Language Summary Title

Improving mental health services for South Sudanese refugees and healthcare workers in Uganda: understanding key factors for success.

Plain Language Summary

There is a growing need for mental health programs that can be offered to more people affected by crisis. However, expanding mental health programs is challenging. In this study, we investigate factors that affect expanding one mental health program, Self Help Plus (SH+), when it is expanded by integrating it with other sectors in Uganda. Data were collected through 50 interviews at the beginning and at the end of the project. People interviewed included staff at BRAC Uganda and MoH, intervention facilitators, and the people that the partners work with (South Sudanese refugees, host communities, and healthcare staff). We analyzed our data by looking at relationships and patterns to identify positive and negative factors that affect expansion of SH+ through integrating with other sectors. We found five major factors that should be considered when expanding SH+. These are (1) simplicity of SH+ makes it easier to adjust parts of the program for integration, (2) challenges in funding make it harder to meet high needs, (3) social connections and relationships help in motivating people to participate, (4) being engaged and involved helps to better integrate, and (5) including ways of building long-lasting programs from the beginning helps continuation of programs in the future. Our findings suggest that integrating SH+ with other sectors may be a helpful way of scaling up SH+. However, finding how people and organizations work together and ways of adjusting the program to better help communities still need to be further explored for better and more sustainable integration.

Search results

Scaling up mental health service provision through multisectoral integration: A qualitative analysis of factors shaping delivery and uptake among South Sudanese refugees and healthcare workers in Uganda