Developing primary mental health services for under-resourced communities emerging from epidemics

Abstract Background The outbreak of Ebola Virus Disease (EVD) is a public health emergency that is not only associated with mortality, but also disproportionally linked to an increased burden of mental disorders in the communities. The disease is associated with social exclusion, physical morbidity, high mortality, and mental health disorders such as depression, anxiety, substance abuse and PTSD; often affecting the survivors, frontline health workers and members of the affected communities. In this article, we describe the process of developing a collaborative stepped care mental health integration model to address the medium and long term Ebola Virus Disease associated mental health problems in a low resource context. Methods The Theory of Change (ToC) methodology was used to guide the process. Three successive ToC workshops were held with a diverse sample of 44 participants drawn both at national and district level; in a district which was the epicenter of the 2022 Ebola outbreak in Uganda. Most of the participants were members of the Ebola Response Task Force. The first 2 workshops were for generating practical ideas on how to address mental health challenges associated with EVD outbreak, while the third and final workshop was for consensus building. Results The stakeholders suggested better mental health outcomes for the general population as the ultimate outcome of the program. This would be preceded by full recovery from the negative mental health effects of the epidemic, improved mental wellbeing for the affected population as well as productivity and functionality. These and several other short-term, intermediate outcomes would have to be achieved following several interventions undertaken at all levels of care. The participants further identified some indicators of successful implementation such as emphasis of mental health in the disaster management plans, mental health indicators in the routine reports etc; as well as some assumptions underlying the intervention. All these were graphically aligned in a causal pathway, leading to a ToC map, contextualizing and summarizing the intervention model. Conclusion The process highlighted the relevance of mental healthcare in building health system outbreak resilience amidst the numerous health system challenges.