"We Are Not Really Marketing Mental Health": Mental Health Advocacy in Zimbabwe.
BACKGROUND
Few people with mental disorders in low and middle-income countries (LMICs) receive treatment, in part because mental disorders are highly stigmatized and do not enjoy priority and resources commensurate with their burden on society. Advocacy has been proposed as a means of building political will and community support for mental health and reducing stigma, but few studies have explored the practice and promise of advocacy in LMICs.


METHODS
We conducted 30 semi-structured interviews with leaders in health and mental health in Zimbabwe to explore key stakeholder perceptions on the challenges and opportunities of the country's mental health system. We coded the transcripts using the constant comparative method, informed by principles of grounded theory. Few interview questions directly concerned advocacy, yet in our analysis, advocacy emerged as a prominent, cross-cutting theme across participants and interview questions.


RESULTS
Two thirds of the respondents discussed advocacy, often in depth, returning to the concept throughout the interview and emphasizing their belief in advocacy's importance. Participants described six distinct components of advocacy: the advocates, to whom they advocate ("targets"), what they advocate for ("asks"), how advocates reach their targets ("access"), how they make their asks ("arguments"), and the results of their advocacy ("outcomes").


CONCLUSIONS
Despite their perception that mental health is widely misunderstood and under-appreciated in Zimbabwe, respondents expressed optimism that strategically speaking out can reduce stigma and increase access to care. Key issues included navigating hierarchies, empowering service users to advocate, and integrating mental health with other health initiatives. Understanding stakeholder perceptions sets the stage for targeted development of mental health advocacy in Zimbabwe and other LMICs.
Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States.|Kushinga, Harare, Zimbabwe.
Reuben
R
Hendler
Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States.|Kushinga, Harare, Zimbabwe.|Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe.
Khameer
K
Kidia
Kushinga, Harare, Zimbabwe.|Department of Psychology, Women's University in Africa, Harare, Zimbabwe.
Debra
D
Machando
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Megan
M
Crooks
Department of Psychiatry, University of Zimbabwe, Harare, Zimbabwe.
Walter
W
Mangezi
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Melanie
M
Abas
Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
Craig
C
Katz
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Graham
G
Thornicroft
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
Maya
M
Semrau
Kushinga, Harare, Zimbabwe.|Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.|Harvard Medical School, Boston, Massachusetts, United States.
Helen
http://orcid.org/0000-0003-2815-4725
H
Jack
D003254:Consumer Advocacy; D006297:Health Services Accessibility; D006801:Humans; D040541:Marketing; D008603:Mental Health; D008605:Mental Health Services; D015030:Zimbabwe