DGHI Professor Receives Grant to Address Mental Illness in Tanzania

Study_Team_Group_Photo

Members of the study team (from left): Joy Noel Baumgartner and her Tanzanian colleagues Paul Lawala, Carina Maboja, Praxeda Swai and Sylvia Kaaya.

Published January 22, 2018, last updated on January 23, 2018 under Research News

Mental illness often takes a devastating toll on one’s life no matter where the affected individual lives, but the burden for people suffering from mental illness in low- and middle-income countries—where treatment options are severely lacking—is particularly difficult to endure.

In sub-Saharan Africa, for example, a major obstacle to getting treatment is the dearth of mental health professionals. Another contributor to the treatment gap is the absence of culturally appropriate evidence-based practices, including models that honor the critical role of caregivers in the treatment process and take traditional beliefs and practices into account.

New Project Aims to Widen Treatment Options in Tanzania 

With a new three-year grant from the National Institute of Mental Health, DGHI assistant professor Joy Noel Baumgartner and her colleagues will aim to address some of these challenges. In one of the first psychosocial randomized controlled trial for adults with psychotic disorders in Africa, they’ll create and pilot a family psychoeducation for adults with psychotic disorders and their relatives in Tanzania. The approach will incorporate both traditional and biomedical ideas about mental illness and include relatives as intervention co-facilitators alongside social workers and nurses.

Family psychoeducation, an evidence-based practice used in high-income countries to help individuals with psychotic disorders and their relatives to cope with the illness, has never been rigorously tested in Africa. “We think this approach has great potential to improve the reach, quality and effectiveness of mental health services for those with psychotic disorders in Tanzania and other similar contexts worldwide,” said Baumgartner.

Training family members to assist in delivering the intervention, says Baumgartner, is one of the more innovative aspects of the grant. This model not only increases the sustainability of the program by minimizing the need for professional health care providers, but is also likely to improve engagement of families in the care of their family members living with mental illness. And, she said, “there’s significant evidence of the positive impact of familial peer support on family outcomes and peer support more broadly for affected individuals.”

Broad Stakeholder Input Will Inform Intervention

The adapted intervention will be based on the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) Family Psychoeducation Evidence Based Practice KIT. The intervention will be called Kuwezeshana kupata uzima (supporting one another for wholeness), or KUPAA, which means “to soar” in Swahili. To develop and culturally tailor the intervention, the team will conduct interviews with patients and their families, clinic-based and traditional mental health care providers and a review panel comprised of American and Tanzanian experts. 

Once KUPAA is finalized, the study team will pilot the program with 72 patient/relative dyads in the Dar es Salaam and Mbeya regions of Tanzania for 12 weeks. They’ll then assess the feasibility and acceptability of the intervention and explore its impact on patient relapse, quality of life and disability.  

Study Will Expand Global Mental Health Expertise

In addition to creating a new family psychoeducation program that has the potential to improve the lives of patients with mental illness and their families in Tanzania, this study will contribute to a growing global mental health evidence base.

While family psychoeducation is promoted as a global best practice, little is known about the underlying mechanisms of action—that is, what changeable factors (e.g. psychological, behavioral, relational) are associated with the cause, severity and course of the disorder and how these factors influence the desired intervention outcomes. This pilot study will explore hypothesized mechanisms of action, including hopefulness for recovery. 

In addition, although researchers and providers across Africa have discussed the need to integrate biomedical and traditional approaches to more effectively treat mental health problems, evidence for how to accomplish this integration is sparse. KUPAA will explicitly and methodically incorporate these two perspectives, an approach that the team hopes will lead to better patient outcomes compared to usual care.

The Team Spans Institutions and Countries

Baumgartner is joined by co-principal investigator Sylvia Kaaya, psychiatrist and dean of the School of Medicine at Muhimbili University of Health and Allied Sciences in Dar es Salaam. Other collaborators include DGHI assistant professor Joseph Egger and study coordinator Jennifer Headley, Tanzanian psychiatrists Praxeda Swai and Paul Lawala, Tanzanian social worker Carina Maboja, and three Columbia University faculty members. Faculty members from the University of KwaZulu Natal, the University of Cape Town and Addis Ababa University are serving as consultants.

The Team Is Already Looking Ahead

Baumgartner and her team are hopeful that this pilot study will lay the foundation for a more robust, six-month randomized controlled trial of a fully manualized KUPAA to determine its impact on patient and family-level outcomes compared to routine psychiatric care in Tanzania. 

In addition, Baumgartner said, while KUPAA will take place in Tanzania, “this research could ultimately contribute valuable information for other populations—including some in the United States—who also hold traditional beliefs and engage in alternative, non-biomedical mental health treatments.”

This research could ultimately contribute valuable information for other populations—including some in the United States—who also hold traditional beliefs and engage in alternative, non-biomedical mental health treatments.

Joy Noel Baumgartner, DGHI assistant professor

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