"they Will Start Believing in Counseling": Provider perceptions of the presentation and treatment of mental illness in Northern Tanzania

The United Republic of Tanzania is at a crucial stage in the development of its mental health system. As of 2009, there were 18 psychiatrists serving this nation of 51 million people despite depression ranking as Tanzania's number one cause of disability. Modest efforts have been made to expand services, but few studies have documented the state of mental health treatment in the nation. The current research represents a formative effort to assess mental health needs in northern Tanzania and inform the investment of resources to improve care. To achieve these aims, we conducted semistructured interviews with 29 mental health providers examining their perceptions of the treatment currently offered, characteristics of patient populations, and future directions in treatment. Responses were analyzed using consensual qualitative research, and these offer nuanced insights into the Tanzanian context. Alcohol and substance abuse, schizophrenia, and stress related to social challenges were the most commonly described mental health concerns. Interviewees acknowledged critical shortfalls in providers, facilities, or resources dedicated to mental health; little coordination among services; and multiple barriers that prevent all but the most severely impaired patients from receiving care. Despite these challenges, the majority of the providers believed that treatment would improve in the future. Implications of these results for the development of the mental health system in Tanzania include the necessity for: (a) improving the availability and quality of services by dedicating new resources, (b) maximizing existing resources through task-shifting and improved training, and (c) addressing barriers to treatment via public education and community outreach.

Duke Scholars

Author Brandon Knettel School of Nursing