Union working group show crucial link between TB and mental health

The Union’s TB and Mental Health Working Group have released a video, Learning from the field: the mental health management of MDR-TB in Peru, to promote the wide-scale provision of mental health screening and services for patients receiving treatment for tuberculosis (TB) worldwide.

Mental health disorders, especially depression, are highly prevalent among people undergoing treatment for TB -- particularly for multidrug-resistant (MDR-TB) strains of the disease. Mental ill health is linked to poorer outcomes for TB patients, and yet measures to support mental wellbeing are rarely incorporated into TB programmes.

The new film explores a Partners in Health (Socios En Salud) project in Peru that in 1996 began one of the  first  treatment programmes for individuals with drug-resistant TB in a low-resource setting. At the time, few believed it would succeed. According to the World Health Organization in 1996, MDR-TB was ‘untreatable’ in these settings. But, in the first cohort of 75 patients, with TB strains resistant to a median of six drugs, 83 percent were cured. Integrated mental health care was critical to success of the programme.

The film highlights the factors that contribute to mental health issues for patients during treatment for MDR-TB, as well as the impact of providing mental health care on treatment outcomes. It features in-depth interviews with a psychiatrist, nurse and a person cured of MDR-TB, describing their experience and perspectives on mental health care.

In the film, Joel Panes talks about his experiences as a patient and how the MDR-TB treatment regimen impacted his mental health. He describes how the mental health care element of the programme – including anti-depressants and group therapy sessions -- supported his recovery.

He said:  “When the group therapy was over we felt better. We had gotten rid of everything that we were feeling inside. It was like a weight had been lifted when we expressed ourselves with people that were going through the same thing. That helped me a lot.”

Humberto Castillo Martell, lead psychiatrist for the programme talks about the value of group therapy, saying that patients benefitted from “knowing they are part of a community, that there are others like them. This seemed to have the greatest therapeutic impact.”

During a recent webinar for The Union, Dr Annika Sweetland, co-chair of The Union’s TB and Mental Health Working Group and Assistant Professor of Clinical Sociomedical Sciences in Psychiatry at Columbia University said: “Depression is a treatable condition that can affect as many as half of all individuals undergoing treatment for TB. It is associated with greater morbidity, mortality, drug-resistance, and community transmission. We think that it is entirely possible that depression may be an unrecognised driver of the TB and MDR-TB epidemics.”

A key aim of the Union’s TB and Mental Health Working Group is to link frontline TB care providers with researchers, to create an evidence base for best practice and to disseminate these to national TB programmes globally. The group is working to identify low-resource settings where TB health-care providers are finding innovative ways of integrating TB and mental health care.

“Treating mental health is strongly aligned to every aspect of the End TB strategy,” said Dr Sweetland. “Effectively treating depression is essential to the fight to end TB.” 

Find out more about The Union’s working groups here.