The development of a Community Mental Health Education and Detection (CMED) tool in South Africa

BACKGROUND: Low demand for mental health services in sub-Saharan Africa is driven by poor mental health literacy, stigma, and poor service availability. OBJECTIVE: To develop a Community Mental Health Education and Detection (CMED) Tool for adults for use by community health teams in South Africa aligned with their roles of health promotion, screening and linkage to care. METHODS: Formative evaluation methods involving four processes: (1) Ongoing engagement with the KwaZulu-Natal Department of Health (KZN DoH) to ensure co-creation of the CMED tool and alignment with routine community health team activities; (2) Adaptation of the CMED tool from the Community Informant Detection Tool (CIDT), used to promote help-seeking of people with mental health problems in Nepal; (3) Review of the CMED vignettes and illustrations by a panel of local and international mental health care experts to establish accuracy and contextual and cultural relevance; (4) Process mapping and focus group discussions (FGDs) with community health teams in one district to establish cultural and contextual appropriateness as well as coherence and compatibility with existing community-based services. RESULTS: The resulting CMED tool consists of five case vignettes and related illustrations to facilitate psychoeducation and the detection of possible depression, anxiety, psychosis, harmful alcohol use, and drug use by community health teams. Based on prototype matching, it includes two structured questions to guide the community health teams in the detection and referral process. The tool was acceptable, culturally and contextually appropriate, and helpful for the services provided by community health teams. Challenges of working in households and the importance of self-care were highlighted as important considerations when developing training content and piloting the tool. CONCLUSION: Extensive consultation with the KZN DoH, community health teams, and the expert mental health panel resulted in developing a tool that was perceived to be culturally sensitive and relevant to the community package of services.