Evaluation of the impacts of a district-level mental health care plan on contact coverage, detection and individual outcomes in rural Uganda: a mixed methods approach

Abstract Background The burden of mental disorders in low- and middle-income countries is large. Yet there is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care. Aim We aimed to evaluate the impact of a district mental health care plan (MHCP) on contact coverage for and detection of mental disorders, as well as impact on mental health symptom severity and individual functioning in rural Uganda. Results For adults who attended primary care facilities, there was an immediate positive effect of the MHCP on clinical detection at 3 months although this was not sustained at 12 months. Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment over 12 months. There was negligible change in population-level contact coverage for depression and alcohol use disorder. Conclusion The study found that it is possible to integrate mental health care into primary care in rural Uganda. Treatment by trained primary care workers improves clinical and functioning outcomes for depression, psychosis and epilepsy. Challenges remain in accessing the men for care, sustaining the improvement in detection over time, and creating demand for services among those with presumed need

Potential strategies for sustainably financing mental health care in Uganda 11 Medical and Health Sciences 1117 Public Health and Health Services 16 Studies in Human Society 1605 Policy and Administration 14 Economics 1402 Applied Economics

Abstract Background In spite of the pronounced adverse economic consequences of mental, neurological, and substance use disorders on households in most low- and middle-income countries, service coverage and financial protection for these families is very limited. The aim of this study was to generate potential strategies for sustainably financing mental health care in Uganda in an effort to move towards increased financial protection and service coverage for these families. Methods The process of identifying potential strategies for sustainably financing mental health care in Uganda was guided by an analytical framework developed by the Emerging Mental health systems in low and middle income countries (EMERALD project). Data were collected through a situational analysis (public health burden assessment, health system assessment, macro fiscal assessment) and eight key informant interviews with selected stakeholders from sectors including health, finance and civil society. The situational analysis provided contextualization for the strategies, and was complimented by views from key informant interviews. Results Findings indicate that the following strategies have the greatest potential for moving towards more equitable and sustainable mental health financing in the Uganda context: implementing National Health Insurance Scheme; shifting to Results Based Financing; decentralizing mental health services that can be provided at community level; and continued advocacy with decision makers with evidence through research. Conclusion Although several options were identified for sustainably financing mental health care in Uganda, the National Health Insurance Scheme seemed the most viable option. However, for the scheme to be effective, there is need for scale up to community health facilities and implementation in a manner that explicitly includes community level facilities

Attitudes towards feminism predict susceptibility to feminism-related fake news

False memories may be especially likely when one is exposed to misinformation that is consistent with one's beliefs. Here, we assessed whether feminist attitudes predict susceptibility to feminism-related fake news. In Experiment 1 (n = 1537), the more negative participants' attitudes towards feminism, the more likely they were to report a false memory for a fabricated event that negatively reflected on the feminist movement, and vice-versa. This effect was only evident for those who interpreted the event as expected (e.g., those who rated the event as bad for feminism). When the purpose of the study was revealed, feminist attitudes also predicted ability to identify the stories as fake. We replicated these findings in Experiment 2 (n = 786), using fake stories that were less ambiguous. This study suggests that individuals are more susceptible to false memories for fake news stories that are ideologically congruent, even after a warning

Language politics and practices in the Baltic states

This monograph provides an overview of the language situation in the three Baltic countries: Estonia, Latvia and Lithuania. It examines the recent change in language regimes that the Baltic States have deliberately brought about since the restitution of their independence, the nature of these changes, the opposition they have engendered and the linguistic, political and social consequences of these policies, both locally and internationally. First, an overview is provided on the historical background to contextualise and present language policy issues in the Baltic. Then attempts to overturn major aspects of Soviet language policy and to re-institute the national language are highlighted. Aspects of the current language situation covered include a special focus on bilingual and multilingual language use in the Baltic multiethnic settings. Detailed attention is also paid to language provision in the diverging educational settings, as well as to methods of assessment. This is followed by a discussion of attitudes to language use, standardisation, testing, languages and language variants. In conclusion the scholarly treatment of Baltic language policy issues is examined, concluding with an evaluation of the contribution of the Baltic States to our overall understandings of language policy and its complexities