title: Beyond the biomedical: community resources for mental health care in rural Ethiopia.
abstract: BACKGROUND
  The focus of discussion in addressing the treatment gap is often on biomedical services. However, community resources can benefit health service scale-up in resource-constrained settings. These assets can be captured systematically through resource mapping, a method used in social action research. Resource mapping can be informative in developing complex mental health interventions, particularly in settings with limited formal mental health resources.
  
  
  METHODS
  We employed resource mapping within the Programme for Improving Mental Health Care (PRIME), to systematically gather information on community assets that can support integration of mental healthcare into primary care in rural Ethiopia. A semi-structured instrument was administered to key informants. Community resources were identified for all 58 sub-districts of the study district. The potential utility of these resources for the provision of mental healthcare in the district was considered.
  
  
  RESULTS
  The district is rich in community resources: There are over 150 traditional healers, 164 churches and mosques, and 401 religious groups. There were on average 5 eddir groups (traditional funeral associations) per sub-district. Social associations and 51 micro-finance institutions were also identified. On average, two traditional bars were found in each sub-district. The eight health centres and 58 satellite clinics staffed by Health Extension Workers (HEWs) represented all the biomedical health services in the district. In addition the Health Development Army (HDA) are community volunteers who support health promotion and prevention activities.
  
  
  CONCLUSIONS
  The plan for mental healthcare integration in this district was informed by the resource mapping. Community and religious leaders, HEWs, and HDA may have roles in awareness-raising, detection and referral of people with mental illness, improving access to medical care, supporting treatment adherence, and protecting human rights. The diversity of community structures will be used to support rehabilitation and social reintegration. Alcohol use was identified as a target disorder for community-level intervention.
authors.affiliation: Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Medhin
authors.initials: M
authors.lastname: Selamu
authors.affiliation: Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Asher
authors.affiliation: Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.affiliation: Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.affiliation: Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Maji
authors.initials: M
authors.lastname: Hailemariam
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
authors.affiliation: Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia; Centre for Affective Disorders and Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D005002:Ethiopia; D006801:Humans; D008603:Mental Health; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012424:Rural Population