Finemind: Integrating mental health services into primary care in Uganda

The Mental Health Issue

In the Agago District of Northern Uganda, a region affected by insurgency, conflict and socio-economic hardship, many people are experiencing psychological distress, anxiety, post-traumatic stress and other mental health challenges. Women and girls are particularly at risk of suffering violence, gender-based discrimination or stigma and are often lacking crucial access to psychosocial counselling, mental health care and support.

The Innovation

The Finemind project works to integrate mental health care services in primary health care facilities, training primary care workers and conducting awareness campaigns on mental health in communities. The innovative, culturally sensitive and highly scalable approach strengthens and builds on existing health care infrastructure and community outreach programmes. Combining local knowledge with evidence-informed mental health interventions, Finemind offers men and women in the district tailored mental health care services in primary healthcare facilities, while sustainably strengthening capacities of local health workers.

Finemind staff on the road to a community to assess mental health needs. Photo: Finemind

The Plan

Finemind’s team of counsellors work both in primary health care facilities and in communities who specialize in promoting health and wellbeing in rural communities. Accompanying Village Health Teams specializing in promoting health and wellbeing in rural communities, Finemind counsellors can mobilize people who may benefit from mental health services. In health centers, the project engages and employs nurses, midwives, clinicians or health assistants who have been trained in identifying, treating and referring people presenting with mental health symptoms. Regular radio shows and mental health awareness events further support increasing mental health literacy and reduce stigma in the community. 

With our project, we are working to integrate mental health as a routine part of general health services in every single health facility across the country. 

Pavel Reppo, Co-founder of Finemind

Finemind’s tailored training programme supports both men and women primary care workers in local health facilities. The curriculum covers evidence-informed mental health interventions including the principles of stepped care interventions, interpersonal counselling, Problem Management Plus (PM+), and essential referral services.  To ensure continued quality of care and professional development, Finemind regularly collects and assesses data on depression severity, functional impairment, patient-defined mental health concerns, and general quality of life. All counselors participating in the project attend a monthly refresher course and receive in-person, specialist supervision and support on a quarterly basis. 

The Impact

Since late 2019, Finemind has provided over 20’000 free counselling sessions to approximately 10’000 patients, with more than 3,500 individuals completing their treatment. Participants report significant improvements in their mental health, with depression symptoms decreasing by an average of 5.5 points. For those with more severe depression, symptoms improve by nearly 10 points, leading to substantial relief from emotional and mental distress and improved well-being. On average, each patient attends four sessions.

Finemind’s approach has also proven cost effective, achieving some 50 units of improved wellbeing measured in Wellbeing-Adjusted Life Years per US$1,000 spent. People experiencing mental health conditions have shared positive feedback on the programme, reporting an average satisfaction score of 4.07 out of 5 upon discharge. Many participants went on to become leaders and mental health champions in their communities, supporting peers who face similar health challenges and breaking the cycle of stigma and isolation. 

Working closely with the Ministry of Health and government officials, Finemind is now working to scale its successful model to other regions of Uganda. 

Finemind team members on a scenic hike, celebrating unity, progress, and the power of community. Photo: Finemind

NCD Lab Cylce 4: Transforming the delivery of NCD and mental health services in primary health care

A radical shift in global public health is needed to avert millions of preventable and premature deaths from noncommunicable diseases (NCDs), including cancer, diabetes, cardiovascular disease, chronic respiratory disease, as well as mental health conditions. Primary health care (PHC) approaches present an important opportunity to transform and innovate how NCD and mental health services are delivered. For its 4th cycle, the NCD Lab – a WHO platform promoting grassroots innovation for NCD prevention and control – called for innovative solutions that strengthen the delivery of NCD and mental health services using the PHC approach. From the more than 80 projects submitted, five promising innovations were selected to be included in the growing global portfolio of leading NCD innovations and receive tailored support to enhance impact and achieve scale.

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NCD Lab: Great ideas start with a spark– and grow from the ground up

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Meaningful Engagement of People Living with NCDs and Mental Health Conditions