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Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.

Hanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, Medhin G, Ssebunnya J, Fekadu A, Shidhaye R, Petersen I, Jordans M, Kigozi F, Thornicroft G, Patel V, Tomlinson M, Lund C, Breuer E, De Silva M, Prince M - PLoS ONE (2014)

Bottom Line: Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers.Nonetheless health system opportunities were apparent.In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ; Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom.

ABSTRACT

Background: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.

Methods: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts.

Results: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care.

Conclusions: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.

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Related in: MedlinePlus

Requirements for integrating mental health into primary health care [14]–[17].
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3928234&req=5

pone-0088437-g001: Requirements for integrating mental health into primary health care [14]–[17].

Mentions: The decades of experience with attempts to integrate mental health care into PHC in LMICs have highlighted the challenges faced on the ground, particularly with respect to sustainability [12]. In order to maximise the beneficial impact of mhGAP, due attention needs to be paid to the process of ‘how to’ successfully implement and scale-up of mental health care in PHC [13]. Evidence and experience to date indicate that stand-alone training of PHC workers in mental health care is necessary but by no means sufficient to guarantee delivery [14]. Other components thought to be necessary are summarised in Figure 1[14]–[17].


Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.

Hanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, Medhin G, Ssebunnya J, Fekadu A, Shidhaye R, Petersen I, Jordans M, Kigozi F, Thornicroft G, Patel V, Tomlinson M, Lund C, Breuer E, De Silva M, Prince M - PLoS ONE (2014)

Requirements for integrating mental health into primary health care [14]–[17].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928234&req=5

pone-0088437-g001: Requirements for integrating mental health into primary health care [14]–[17].
Mentions: The decades of experience with attempts to integrate mental health care into PHC in LMICs have highlighted the challenges faced on the ground, particularly with respect to sustainability [12]. In order to maximise the beneficial impact of mhGAP, due attention needs to be paid to the process of ‘how to’ successfully implement and scale-up of mental health care in PHC [13]. Evidence and experience to date indicate that stand-alone training of PHC workers in mental health care is necessary but by no means sufficient to guarantee delivery [14]. Other components thought to be necessary are summarised in Figure 1[14]–[17].

Bottom Line: Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers.Nonetheless health system opportunities were apparent.In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia ; Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, United Kingdom.

ABSTRACT

Background: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.

Methods: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts.

Results: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care.

Conclusions: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.

Show MeSH
Related in: MedlinePlus