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Today, 450 million people worldwide live with a mental illness. According to the World Health Organization, one in four of us will experience a mental or neurological disorder during our lifetime. Depression is the leading cause of disability around the world. Yet low-income countries generally lack the human resources necessary to provide adequate care for the mentally ill, resulting in an astonishing treatment gap. Pavel Reppo founded a non-profit called mindfullwe in order to address this problem, and just finished his pilot program of community-based mental health support in Uganda.
“ We recruit, train and employ local community members to provide basic therapeutic support services to individuals struggling with depression ,” Pavel says. The work is steeped in task-sharing, whereby the few specialists on-the-ground in the country are reallocated to offer oversight, quality assurance, and supervision so that lesser-trained workers can be empowered to act as the frontline in mental health support. The stepped care these workers provide includes 1) psychoeducation: offering practical advice in coping with problems, 2) antidepressant drug therapy, 3) interpersonal counseling: which focuses on understanding the relationship between symptoms and triggers, and if necessary, 4) referral to a mental health specialist.
Moving forward, mindfullwe intends to partner with vetted organizations around the world to run similar programs, sharing a functional playbook detailing the steps to effectively replicating the program in other geographical locales. Their hope is to catalyze a shift towards community-based mental health services.
Reppo says he was inspired to pursue his life purpose of facilitating groundbreaking work in mental healthcare by Tom Chi, a pioneer in rapidly prototyping solutions to different problems. But also, he was inspired to found mindfullwe based on his personal experience with mental illness. “At 13, I found myself washing my hands for 45 minutes at a time. My hands began to crack and bleed, and yet I could not stop. I was in the cold grip of obsessive-compulsive disorder (OCD). Since that fated day, I've had an outpouring of support to reclaim my life. Even so, it has been far from easy. I’m rounding the corner on five years of behavioral therapy, a year with an OCD expert, several bouts of medication, and keeping up-to-date with the latest literature and research in OCD management. And I’m one of the lucky ones.”
The global mental health landscape is bleak, Reppo reports. On average, there is only one psychotherapist for every 200,000 or more people in the world. In Africa, most countries spend less than 1% of their health budgets on mental health care. The World Health Organization posits that one of the most important recommendations for improving healthcare globally is integrating mental healthcare into primary care settings, which includes screening, assessment and treatment. One simple and effective solution is task-sharing: using non-professionals trained in brief, intense therapies to offer services. “By no means did I ‘invent’ this solution,” Reppo explains. “However, I am undaunted in applying task-sharing to bridge the global mental health treatment gap.”
Reppo shares the story of a patient, whom we’ll call Jane, who came into a Uganda health clinic for a check-up for her one-year-old daughter. After sitting down with a health worker trained by mindfullwe, Jane confessed that she had been struggling with severe stress for months, stemming from her separation from her husband, taking care of three children as a single mother, and being the sole provider for her family, including her mother and sister. On top of that, she recently had lost her job. The night before, she had made the decision to take her life. She had cooked a local Ugandan dish and planned to purchase rat poison to mix with the food.
Luckily, the mindfullwe health worker was able to understand the diagnosis of depression, manage Jane’s suicidal risk, and offer practical advice. This timely intervention may have saved Jane’s life, and saved her three children from growing up without a mother.
“This anecdote shows just how meaningful our work is,” Reppo says. While he finds the constant travel back and forth between Colorado and Uganda exhausting, he is passionate about what he does. “We literally save lives. Other patients report having more interest and pleasure doing things. Most are more upbeat, resilient, and hopeful.”
Nevertheless, pursuing this career path takes its toll on Reppo’s own physical and mental health. “I’ve noticed that I am willing to give everything I have in order to see mindfullwe flourish. In doing so, I subject myself to ungodly work hours, expectations, and standards. I don’t extend compassion to me, and end up hurting myself. I’m learning to understand that it is not okay to give up my health for another pursuit,” he says.
In pursuing your life purpose, Reppo recommends “a horizontal approach where you experiment doing things that may be completely unrelated. Listen to what grips and interests you, what sours you and pushes you away. A close cousin of this is, be willing to look silly or foolish in new endeavors. Frankly, if you are focused on tapping into your life purpose, it’s not going to matter in the long run how it appears to someone else.”
