Healthy Minds Telecounselling services

Increasing access of counselling services through mobile technology for Basotho

Lesotho is a country situated in the southern part of Africa, with a population of 2.2 million, the second highest HIV prevalence (25%) globally, and over half (57%) of the population living in poverty. Access to health services in Lesotho is challenged by factors such as the countries topography, since two thirds of the population is mountainous and people have to travel long distances to the health facilities. With regards to the countries’ mental health landscape, service access is hindered mostly by poor mental health awareness and a shortage of mental health workers.

Lesotho has 2 mental health professionals per 100,000 population, bringing the total to 40 mental health professionals in the country.  Access of mental health services is challenged by the countries topography, since two thirds of the population is mountainous and people have to travel long distances to the health facilities. The absence of a psychiatrist serving the nation is of utmost concern, and psychiatric needs are met by a few psychiatric nurses distributed in some of the hospitals in the country, 2 foreign general practitioners who are based in the National psychiatric hospital and serving the entire nation. The total of qualified psychologists in Lesotho is below 10, with only 2 Clinical psychologists serving the entire population. In addition, there is a high number of low level counselors who are unemployed and not absorbed into the public and private sector.

To meet this service access challenge, an innovative and efficient solution is required. As a clinical psychologist working in private practice in Lesotho, My team has have been subcontracted by a foreign wellness organization to provide telephone counselling services to one of their clients in Lesotho (bank & NGO employees). The employees have a positive response to this form of counselling over face-to-face counseling, since it is efficient, anonymous and does not require travel to the psychologist’s office. We would like to extend this service to the broader public including mobile network users, private companies and health insurance companies.

Ninety percent of the population has cellphone mobile access and we anticipate partnerships with mobile network users, local health insurance companies as well as the private and public sector. This model involves the provision of counselling in the form of psycho education and supportive therapy services on a wide range of psychosocial stressors ranging from teenage problems to depression, among others, through the utilization of mobile technology. There will also be weekly dissemination of mental health information via sms to mobile users as a health promotional awareness strategy. This telephone counselling service would utilize low level counselors to deliver the service under supervision by the clinical psychologist. This strategic model would be the first of its kind in Lesotho and is in line with SDG 3; ensuring healthy lives and promoting well-being for all at all ages. This initiative would be increasing access and awareness of mental health services in Lesotho while building capacity for low level workers. Mobile networks are enthusiastic about this intervention and have indicated their interest. With an expansive access of telephone counseling, psychosocial support service provision would increase, thereby improving the mental health of Basotho and therefore decreasing the load on the already burdened public health system.

Counselling services in Lesotho adopt a face to face model where clients physically access counselling services.  While there are existing helplines for a targeted population such as a national child helpline, there are challenges with the functionality. Telephone counselling services in Lesotho is a new phenomenon.This product would be available for the broader public, with anticipated partnerships with mobile networks, local universities, health insurance companies and government.The use of mobile applications to purchase counselling service bundles and receive telephone counselling services through their phone is a new phenomenon.

Technology is integral to my solution. This solution involves the use of mobile technology to deliver counselling services.The use of a calling system where  clients in need of counselling services will phone the counselling call center and be assisted by supervised counsellors. Mobile users would utilize their phones to select the service through the already existing mpesa application and purchase counselling bundles through their phones. Then phone the call center to receive telephone counselling.

-Establish a Memorandum of Understanding with Mobile Networks to provide telephone counselling through their networks.

-Establishment of a call center line and tool required

-Recruitment and training of 20  low level counselors

-National launch of the telephone counselling product

-Inclusion of the telephone counselling service package in the 2 local medical aid companies

-Lobbied Telephone counselling service to 10 private companies

-Established links with Ministry of Police & Safety as well as Ministry of Health in case of any emergencies

In the next three to five years, I envision strong partnerships with the local university, local and foreign medical aid insurance companies, government, private and Non-governmental organizations.

-Provided 100 internships to low-level counselling graduates from the National University.

-Expanded telephone counselling service package to 5 foreign Medical aids.

-Established telephone counselling service to 70 percent of the private sector

-Provided telephone counselling to 80% of the mobile network users in Lesotho

-Achieved a partnership with Government for a 100 percent subsidized service rate for vulnerable groups (Youth, women, elderly, orphans, unemployed)

-Increase mental health awareness to 100 percent of Basotho

Awareness is key to this solution therefore in addition to provision of telephone counselling services, my company will be sending out mental health themed messages weekly to mobile users, to increase awareness and increase utilization of the service. Mobile users will be phoning into the call center and receive counselling services over their cellphones. The mobile network has an already existing application called mpesa, where mobile users can purchase airtime and pay utilities. The plan is to include counselling bundles available for purchase, following that they will phone in and be directed to a counsellor for services.

I am subcontracted by a foreign wellness company to provide face-to face and telephone counselling services for their clients in Lesotho (standard bank Lesotho, Mothers to mothers NGO). The clients I serve mostly work outside of the capital and have difficulty accessing to counseling services. Through telephone counselling, I have managed to provide counselling services to 100 individuals, a majority of  who work in the rural areas of Lesotho. Clients prefer the service because of its efficiency in that there is no need to travel to the psychologists  office, and clients can remain anonymous over the phone therefore increasing rapport.

Awareness and acceptability of counselling services is largely poor in Lesotho, particularly in the rural population. In the next twelve months I envision to have mobilized usage of this service in the urban areas, with expanded telephone counselling service package to medical aid users, private organizations, and 80 percentage of mobile users. With the rural population constituting 72% of the country, an intensified awareness strategy is needed to create acceptance of the service. In the third year, I envision that 80 percent of the rural population will have greater awareness and acceptability of the service through radio and mobile messages.

We are all in the mental health profession. I am a Clinical psychologist with 12 years of experience both in the public and private sector of Lesotho. I have extensive experience in wellness organisations. I am affiliated with 3 foreign wellness organisations, which have clients in Lesotho. I have 2 social workers, who have also worked in the public system previously. We have made networks with several organisations and NGOs and are hoping to mobilise them to affiliate with our company for telephone counselling provision for their employees.

Our current revenue model is through affiliation with the foreign wellness groups. At this stage telephone counselling is only provided through this organisation. Long term sustainability is envisioned through the plan to lobby private organisations and NGOs to adopt telephone counselling as an employee benefit. I plan to lobby health insurance companies to adopt include this service in their package. The plan is to also lobby organisations and government to subsidise the service, particularly to key populations e.g youth, in future.

I am applying to solve for the networking, coaching and funding opportunity. I believe solve can advance my work through the constructive feedback which I would receive from the MIT campus. Secondly because my solution is technology based, my team and myself would require training and coaching on call center management. I would also like to grow a network with organisations who are in the same field as myself to exchange learning and growth opportunities. Lastly, because of the huge demand that will be placed on the expansion of this service, funding will be required to meet the demand.

Some of the barriers for my solution are that my team and myself have been providing telephone counselling through our regular phones. The expansion into a call center will require call center management training for the team. To meet of the high demand that the expansion of the service will create, an increased supply of counsellors will be required to ensure prompt service. We are currently operating in a small space, expansion of this service would require a larger space to ensure adherence to  ethical principles of counselling. Therefore funding is required to meet the labor intensiveness and infrastructure needs.