Lay community health workers and mental health services in low resource settings: Group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in northern Uganda

The thesis is premised on a public mental health perspective, and is informed by my interest in working with and developing task shifting/sharing initiatives in low resourced settings. Based on my experience with nodding syndrome (NS), a mysterious neuropsychiatric illness affecting children in northern Uganda, I sought to answer questions relating to the roles and utilization of lay community health workers (LCHWs) within health systems in low and middle-income countries (LMICs). I use outcomes from research studies that employed varied methods including a systematic literature review, qualitative and quantitative methods. The burden and nature of mental health problems associated with NS, task shifting initiatives to deliver psychological treatments in LMICs, as well as key intervention outcomes relating to the contextualization and effectiveness of group interpersonal therapy (IPT-G) for caregivers and their children affected by NS are discussed. The positive impact of IPT-G on both the intended beneficiaries (caregivers and their children) and providers (LCHWs) informs my discussion about syndemic approaches to care, as a model for public mental health care that demands further research in LMICs. The thesis concludes with insights and recommendations on the need to include emic and etic perspectives in determining burden of mental illness or disease, utilization of LCHWs to deliver effective public mental health interventions within LMICs, the importance of systematic contextualization of evidence based treatments as a prerequisite to scale up, and the need for ‘dual’ generation and syndemic interventions to address children and adolescent mental health problems