Consultants template NATIONAL FORENSIC MENTAL HEALTH SERVICES PACKAGES IN ZIMBABWE

1. Purpose of the Consultancy

The purpose of this engagement is to provide technical support in the development of National Mental Health Forensic Services packages. The consultant will be expected to work closely with MOHCC, WHO and other mental health practitioners and partners on this.

2. Background

Around the world, mental health services are striving to provide quality care and support for people with mental health conditions or psychosocial disabilities. Yet often services face substantial resource restrictions, operate within outdated legal and regulatory frameworks and an entrenched overreliance on the biomedical model in which the predominant focus of care is on diagnosis, medication and symptom reduction while the full range of social determinants that impact people’s mental health are overlooked[1].

Forensic mental health services (FMHSs) provide treatment and rehabilitation for persons with mental disorders and interfacing with the justice system or diversion mechanism where aspects of therapeutic safety and security are major concerns. Forensic services also concern issues of determination of capacity and competency of persons to execute specific tasks or manage personal affairs. Hence, Forensic mental health services here refers to a therapeutically safe mental health service to a selected population, not only forensic hospitals but also integrated, coordinated systems of care across the interface of criminal justice and mental health services. The legal regime in Zimbabwe set standards upon which Forensic Mental Health care is to be implemented as can be found in; (Constitutions, mental health act, court procedures act, guardianship act, employment act, management of estates act, contract act, road safety act, marriage, retirement, etc)

In terms of institutional care of Forensic cases in Zimbabwe, people with mental a mental illness are admitted to the two forensic institutions of Chikurubi and Mlondolozi from other hospitals, the community, or the criminal justice system because of a perceived or confirmed criminal offense as a result of or influenced by their mental health condition and undergo intensive, and restrictive care and treatment. Ideally, Forensic mental health services specialize in the assessment, treatment and risk management of people with a mental illness who are currently undergoing, or have previously undergone, legal or court proceedings, or are deemed to have committed an offense that is attributable to their mental illness. The delivery of clinical services for persons with mental illness is usually poorly organized, and standards of practice are highly variable. Care can be inconsistent, with variation in standards and in models of care and due to staff shortages best evidence is not routinely implemented[2]. Other parts of the health sector have been more effective at implementing consistent service standards, including treatment as usual linked to clinical trials and service research aimed at driving improvement. Quality programs are necessary to ensure that services meet a minimum standard and uphold the human rights.[3]

There also seems to be lack of fluidity, coordination, support and liaison between general and forensic mental health services. The available services seem to be unknown or misunderstood by important stakeholders and the general public of Zimbabwe.[4] Moreover, any form of mental health services in the community to re-integrate persons existing forensic mental health services into communities is not clearly defined. Therefore, the role of community support systems are not well utilized.

The Government of Zimbabwe with support from the World Health Organisation is working towards developing a holistic mental health services package as evidenced by the establishment of working committee on mental health services package. The committee has so far developed a framework for general mental health services packages. The same committee recognized and recommended the need for the development of a forensic mental health services package.

It is therefore necessary to engage a consultant to facilitate the development of a forensic mental health services package that ensures better-coordinated, predictable and standard protocols for effective use of limited resources and thus improve the scale and quality of forensic mental health programming.

General

The consultant will facilitate the development of forensic mental health services package. The consultant will work through the Mental Health Materials Services Package working group with guidance from the Forensic Mental Health taskforce, MOHCC, Ministry of Justice, VSO, the University of Washington and WHO.

3. Scope of work

In alignment with the national mental health strategic plan and under the overall guidance of the WHO Representative in Zimbabwe, the consultant will work closely with MOHCC, Ministry of Justice, local experts, VSO, WHO technical team, University of Washington, and other partners in NCDs and mental health to:

a) Review the legal regime in Zimbabwe and abstract and define the scope of the aspects of Forensic Mental Health in the legislations of the country

b) To develop/adapt/adopt a range of mental health services including promotive, preventive, treatment and care services that can be provided when integrated into the health care system, covering all age groups and special conditions through all the levels of the Forensic healthcare system

c) Deliver a final version of the National Forensic Mental Health Services packages cleared by the WHO Zimbabwe Country Office, MOHCC, the Ministry of Justice, VSO and partners.

d) Develop treatment guidelines/protocols/SOPs and Establish a training program to strengthen and integrate Forensic MH into services at primary, community and social care services (e.g. screening for common MH conditions and substance use, multidisciplinary team support, mhGAP, psychological interventions, PFA, FB and Self Help Plus training)

e) Develop a clear referral pathway and an integration strategy

f) Develop minimum knowledge and skills required for each level of care

4. Concrete deliverables and timelines

· Summary of legal Regime with draft definition of the scope of Forensic Mental Health Services presented to the technical working group within first two weeks of deployment. List of key stakeholders identified.

· First Draft Forensic Mental Health Services presented to the TWG by one month of deployment

· Validation meeting by 8th week

· Final Validated National Forensic Mental Health Services packages document defining each of the healthcare system level (from community to tertiary) covering all age groups and specific health conditions strategy. Delivered by 12th week of the assignment.

· Report on the process and engagements by the 12th week of the assignment.

5. Education and Experience

Educational qualifications:

Essential: A Masters degree in Clinical psychology, Psychiatry or Global Mental Health from a recognized university.

Desired: PhD in a relevant field will be an added advantage

- Experience required:

a) Minimum of five(5) years relevant work experience in public mental health facilities

b) Familiar with the Forensic, health system and community system in Zimbabwe

c) The consultant should have proven record of similar assignment with reputable institutions.

d) Experience working with the corporate world, UN system or other global/international

6. Skills and Competencies

Skills

a) Sound technical knowledge on mental health interventions

b) Technical writing skills, good facilitation skills, knowledgeable in basic computer programs, efficient organizational and management skills

Competencies

· Technical Competence

· Overall Attitude at Work

· Teamwork

· Respecting and Promoting Individual and Cultural Differences

· Communication

[1] Guidance on community mental health services Promoting person-centred and rights-based approaches. World Health Organization 2021

[2] Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services Harry G. Kennedy, Alexander Simpson and Quazi Haque 2019

[3] Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services Harry G. Kennedy, Alexander Simpson and Quazi Haque 2019

[4] Community Resources for Forensic Mental Health Aftercare in Zimbabwe Sinqobile Patience Ncube-Sibanda, Virgininia Dube-Mawerewere College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe 2019