Tackling mental ill-health is a major global challenge. More than 450 million suffer from mental illness globally (WHO 2015). Nearly 75% of the 450 million people worldwide diagnosed with a mental illness live in the developing world, and 85% of these people have no access to treatment*. There is a critical need, therefore, to come up with new approaches to providing the right support and services to deal with the scale of the global mental health challenge.
The SHM Foundation is addressing this critical need. How? Using SMS text messaging as a tool for increasing access to mental health support groups for adolescents in South Africa, through their ‘Project Khuluma’. The Khuluma model is an SMS platform that facilitates interactive, closed support groups of 10 to 15 participants. The project has worked with 99 HIV positive adolescents in South Africa so far and they are about to launch their next set of support groups on the 10th of October on World Mental Health Day. Participants are able to communicate amongst themselves, with a facilitator and mentor via mobile phone about any topic that they deem important to discuss. Uptake of the project has been high with over 40,000 SMSs sent amongst 99 participants in three months. Topics of discussion include social stigma, isolation, loneliness, difficulties taking medication, having relationships and aspirations for the future.
There are three reasons why the Khuluma model uses SMS as its primary tool for tackling mental ill-health among HIV positive adolescents.
- SMS breaks down barriers of access. Often, people living with chronic health conditions or mental illnesses don’t have the funds or time to travel regularly to a support group. This is particularly a problem for those in rural areas, because mental health services tend to be concentrated in cities.
- SMS provides anonymity and immediacy. Text messaging feels different to communication face-to-face. There is less sense that you’re talking to someone, less interruption and there can be 100% anonymity. There is evidence to suggest that the mental and social processes that go on in our brains when in an SMS conversation are different and even better for addressing mental health problems. SMS text messaging is confidential and unobtrusive, meaning people are often more willing to open up about their feelings and problems.
- SMS allows for the collection of quality data. One of the big barriers to addressing the global mental health crisis is that we don’t know enough about it. We lack quality data on the problems that face people, particularly in the developing world, and the extent to which they can access treatment or social support. Using SMS not only allows us to scale up access to social support, but also allows us to generate more qualitative and quantitative data that is more accurate about the problem we’re trying to solve. People are particularly more likely to give accurate information via text on touchy or stigmatised subjects.
Project Khuluma has provided a platform for much needed psychosocial support for HIV positive adolescents helping to tackle some of the detrimental impacts of social isolation and stigma that they face. For those who have taken part in our support groups, there have been significant positive health outcomes:
- Decreased levels of anxiety and depression
- Increased levels of social support
- Decreased feelings of internalised stigma
- Increased knowledge about their health condition and how to access specific services
Over the next couple of months the SHM Foundation will be looking at how to apply this model to other health conditions where social isolation and stigma are a factor. They are looking for partners and supporters to roll out this model in South Africa and elsewhere.
Project Khuluma has been very generously supported by BulkSMS. You can follow the project on Twitter @SHMFoundation to keep up to date on findings and insights. You can also learn more by visiting the website, or reading a case study on the Mental Health Innovation Network.
*Collins, P.Y., Patel, V., Joestl, S. S, March, D., Insel, T.R, & Daar, A.A (2011). Grand challenges in global mental health: A consortium of researchers and advocates and clinicians announces here research priorities for improving the lives of people with mental illness around the world, and calls for urgent action and investment. Nature, 475 (7354), 27-30.