PIH Malawi: Abwenzi Pa Za Umoyo (APZU)

APZU’s mental health program was developed in 2016 to focus on mental health integration into APZU’s   Integrated Chronic Care Clinic (IC3)   in Neno District, which utilizes two hospital-based teams that support all health centers in the district. The IC3 clinic primarily treats people with psychosis, schizophrenia, epilepsy, and mood disorders, often associated with side effects from HIV or epilepsy medications and extends to those who have relapsed from lack of treatment or medication adherence. The mental health program incorporates depression case-finding and treatment into HIV services, primary care, and maternal care. They conduct community visitations for patients with epilepsy who have compromised movement or are reluctant to visit the health facility. The team has grown to include clinical officers, a psychologist, program management, monitoring and evaluation staff, and a staff wellness team who work across 14 facilities. APZU uses the MESH MH model to improve supervision and enhance mentorship across facilities, whereby mental health clinical officers travel to each facility to mentor fellow members of the team.

Through the MVC, APZU implemented a Group PM+ psychological intervention in 2019 to treat perinatal depression at Nsambe Health Center. The team adapted PM+ training manuals and trained lay mental health counselors who screen mothers for depression at routine antenatal visits. So far, 77 people have participated in the intervention and preliminary data sshows that over 90% of patients’ depression improved from moderate and severe to minimal or no depression at all after the intervention. Data also indicate that over 90% of patients that benefitted from the intervention remained stable with no depression 6 months after completing Group PM+ therapy. The team engages with communities through outreach and radio talks. APZU is also piloting CETA, focusing on people who have experienced gender-based violence and substance abuse. The team is conducting research projects on active case findings, referrals, linkage to care for clients with mental illness in IC3 and the Advanced Mental Health Clinic, as well as coordinating with local pharmacies to prescribe psychiatric and anti-epileptic medication.   

In the wake of COVID-19, APZU did extensive community work with active case finding and spoke on radio shows about the impacts of COVID-19 and mental health such as stigma, discrimination, anxiety, and depression. The team provided PFA trainings for over 100 non-specialist front-line healthcare workers to share crucial basic psychological skills, crucial for many staff without prior mental health treatment experience. APZU is also one of two PIH sites that led piloting staff wellness and peer support programs as part of a OnePIH working group to share lessons on staff wellness across the organization.  Activities underway include virtual and in-person individual and peer support groups, workshops, online resources, education, and psychological support.   

• Scale up CETA for those affected by GBV and substance abuse and raise community awareness 
• Evaluate and disseminate the Impact of Group PM+  
• Improve screening and treatment of perinatal depression and support economic empowerment activities among perinatal women  
• Enhance staff wellness and peer support activities 
• Strengthen capacity to delivery psychological interventions for priority conditions such as people affected by COVID-19, substance use, and gender-based violence  
• expand social support and economic empowerment activities in partnership with the  POSER  program 
• Support IC3-D activities through complementary funding by the National Institute of Mental Health  

•  MESH MH Mentor Checklist 
•  Integrated Care Cascade Toolkit 
•  APZU Mental Health Innovation Network Profile