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District mental healthcare plans for five low-and middle-income countries: Commonalities, variations and evidence gaps

Published online by Cambridge University Press:  02 January 2018

Charlotte Hanlon ,
Abebaw Fekadu ,
Mark Jordans ,
Fred Kigozi ,
Inge Petersen ,
Rahul Shidhaye ,
Simone Honikman ,
Crick Lund ,
Martin Prince  and
Shoba Raja
...Show all authors
Charlotte Hanlon*
Affiliation:
College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia and Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Abebaw Fekadu
Affiliation:
College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
Mark Jordans
Affiliation:
Research and Development Department, Amsterdam, The Netherlands and Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Fred Kigozi
Affiliation:
Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda
Inge Petersen
Affiliation:
School of Applied Human Sciences, Howard College, University of KwaZulu-Natal, Durban, South Africa
Rahul Shidhaye
Affiliation:
Public Health Foundation of India, New Delhi, India and CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
Simone Honikman
Affiliation:
Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Crick Lund
Affiliation:
Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa, and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Martin Prince
Affiliation:
Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Shoba Raja
Affiliation:
BasicNeeds, Banasawadi, Bangalore, India
Graham Thornicroft
Affiliation:
Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Mark Tomlinson
Affiliation:
Centre for Public Mental Health, Department of Psychology, Stellenbosch University and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Vikram Patel
Affiliation:
Public Health Foundation of India, Bhopal, Madhya Pradesh, India, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Sangath, Goa, India
*
Charlotte Hanlon, Department of Psychiatry, 6th Floor College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, PO 9086, Ethiopia. Email: charlotte.hanlon@kcl.ac.uk
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Abstract

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Background

Little is known about the service and system interventions required for successful integration of mental healthcare into primary care across diverse low- and middle-income countries (LMIC).

Aims

To examine the commonalities, variations and evidence gaps in district-level mental healthcare plans (MHCPs) developed in Ethiopia, India, Nepal, Uganda and South Africa for the PRogramme for Improving Mental health carE (PRIME).

Method

A comparative analysis of MHCP components and human resource requirements.

Results

A core set of MHCP goals was seen across all countries. The MHCPs components to achieve those goals varied, with most similarity in countries within the same resource bracket (low income v. middle income). Human resources for advanced psychosocial interventions were only available in the existing health service in the best-resourced PRIME country.

Conclusions

Application of a standardised methodological approach to MHCP across five LMIC allowed identification of core and site-specific interventions needed for implementation.

Type
Papers
Information
The British Journal of Psychiatry , Volume 208 , Issue s56: Mental health plans in five low- and middle-income countries: PRogramme for Improving Mental health carE (PRIME) , January 2016 , pp. s47 - s54
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Copyright
Copyright © Royal College of Psychiatrists, 2016

Footnotes

This paper was produced as part of PRIME funded by UK aid from the UK government. However, the views expressed do not necessarily reflect the UK government's official policies.

Declaration of interest

None.

References

1 World Health Organization. Mental Health Gap Action Programme (mhGAP): Scaling Up Care for Mental, Neurological, and Substance Use Disorders. WHO, 2008.Google Scholar
2 World Health Organization, Wonca. Integrating Mental Health into Primary Care. A Global Perspective. WHO and World Organization of Family Doctors, 2008.Google Scholar
3 Patel, V, Thornicroft, G. Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries. PLoS Medicine series. PLoS Med 2009; 6: e1000160.CrossRefGoogle ScholarPubMed
4 Thornicroft, G, Alem, A, Antunes Dos Santos, R, Drake, RE, Gregorio, G, et al. WPA guidelines on steps, obstacles and mistakes to avoid in the implementation of community mental health care. World Psychiatry 2010; 9: 67–77.CrossRefGoogle Scholar
5 Barbui, C, Dua, T, van Ommeren, M, Yasamy, MT, Fleischmann, A, Clark, N, et al. Challenges in developing evidence-based recommendations using the GRADE approach: the case of mental, neurological, and substance use disorders. PLoS Med 2010; 7: e1000322.Google Scholar
6 Dua, T, Barbui, C, Clark, N, Fleischmann, A, Poznyak, V, van Ommeren, M, et al. Evidence-based guidelines for mental, neurological, and substance use disorders in low- and middle-income countries: summary of WHO recommendations. PLoS Med 2011; 8: e1001122.Google Scholar
7 Lund, C, Tomlinson, T, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 2012; 9: e1001359.Google Scholar
8 Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS One 2014; 9: e88437.CrossRefGoogle ScholarPubMed
9 World Health Organization. mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings. WHO, 2010.Google Scholar
10 Campbell, NC, Murray, E, Darbyshire, J. Designing and evaluating complex interventions to improve health care. BMJ 2007; 334: 455–9.Google Scholar
11 Fekadu, A, Hanlon, C, Medhin, G, Alem, A, Selamu, M, Giorgis, TW, et al. Development of a scalable mental healthcare plan for a rural district in Ethiopia. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153676).Google Scholar
12 Jordans, MJD, Luitel, NP, Tomlinson, M, Komproe, IH. Setting priorities for mental health care in Nepal: a formative study. BMC Psychiatry 2013; 13: 332.CrossRefGoogle Scholar
13 Kigozi, NF, Kizza, D, Nakku, J, Ssebunnya, J, Ndyanabangi, S, Nakiganda, B, et al. Development of a district mental healthcare plan in Uganda. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153742).Google Scholar
14 Petersen, I, Fairall, L, Bhana, A, Kathree, T, Selohilwe, O, Brooke-Sumner, C, et al. Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153726).Google Scholar
15 Shidhaye, R, Shrivastava, S, Murhar, V, Samudre, S, Ahuja, S, Ramaswamy, R, et al. Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153700).Google Scholar
16 Padmanathan, P, De Silva, M. The acceptability and feasibility of task-sharing for mental healthcare in low and middle income countries: a systematic review. Soc Sci Med 2013; 97: 82–6.CrossRefGoogle ScholarPubMed
17 Cohen, A. The Effectiveness of Mental Health Services in Primary Care: The View from the Developing World. World Health Organization, 2001.Google Scholar
18 Jordans, MJD, Luitel, NP, Tomlinson, M, Komproe, IH. Setting priorities for mental health care in Nepal: a formative study. BMC Psychiatry. 2013; 13: 332–40.Google Scholar
19 Connell, J, Kubisch, A. Applying a Theory of Change Approach to the Evaluation of Comprehensive Community Initiatives: Progress, Prospects, and Problems. The Aspen Institute, 1998.Google Scholar
20 Breuer, E, De Silva, M, Fekadu, A, Luitel, NP, Murhar, V, Nakku, J, et al. Using workshops to develop Theories of Change in five low and middle income countries: lessons from the Programme for Improving Mental Health Care (PRIME). Int J Ment Health Syst 2014; 8: 15.CrossRefGoogle ScholarPubMed
21 Breuer, E, De Silva, MJ, Shidaye, R, Petersen, I, Nakku, J, Jordans, MJD, et al. Planning and evaluating mental health services in low- and middle-income countries using theory of change. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153841).Google Scholar
22 Ritchie, J, Spencer, L. Qualitative data analysis for applied policy research. In Analysing Qualitative Data (eds Bryman, A, Burgess, RG): 173–94. Routledge, 1994.Google Scholar
23 Chisholm, D. WHO mhGAP Costing Tool for Mental, Neurological and Substance Use Disorders. World Health Organization, 2011.Google Scholar
24 Chisholm, D, Burman-Roy, S, Fekadu, A, Kathree, T, Kizza, D, Luitel, NP, et al. Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: the PRIME study. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153866).Google Scholar
25 Department of Health. Primary Care 101: Symptom-Based Approach to the Adult in Primary Care. Department of Health, 2012.Google Scholar
26 BasicNeeds. Community Mental Health Practice. Seven Essential Features for Scaling Up in Low- and Middle-Income Countries. BasicNeeds, 2009.Google Scholar
27 Eaton, J, Agomoh, AO. Developing mental health services in Nigeria. The impact of a community-based mental health awareness programme. Soc Psychiatry Psychiatr Epidemiol 2008; 43: 552–8.CrossRefGoogle ScholarPubMed
28 Shibre, T, Kebede, D, Alem, A, Negash, A, Kibreab, S, Fekadu, A, et al. An evaluation of two screening methods to identify cases with schizophrenia and affective disorders in a community survey in rural Ethiopia. Int J Soc Psychiatry 2002; 48: 200–8.CrossRefGoogle Scholar
29 Nkonki, L, Cliff, J, Sanders, D. Lay health worker attrition: important but often ignored. Bull World Health Organ 2011; 89: 919–23.Google Scholar
30 Clark, J. Medicalization of global health 2: the medicalization of global mental health. Glob Health Action 2014; 7: 24000.CrossRefGoogle ScholarPubMed
31 Collins, PY, Patel, V, Joestl, SS, March, D, Insel, TR, Daar, AS. Grand challenges in global mental health. Nature 2011; 475: 27–30.Google Scholar
32 Hanlon, C, Tesfaye, M, Wondimagegn, D, Shibre, T. Ethical and professional challenges in mental health care in low- and middle-income countries. Int Rev Psychiatry 2010; 22: 245–51.Google Scholar
33 de Menil, VP, Knapp, M, McDaid, D, Njenga, FG. Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance. PLoS One 2014; 9: e90297.Google Scholar
34 Blanchet, K, James, P. Can international health programmes be sustained after the end of international funding: the case of eye care interventions in Ghana. BMC Health Serv Res 2014; 14: 77.Google Scholar
35 De Silva, MJ, Rathod, SD, Hanlon, C, Breuer, E, Chisholm, D, Fekadu, A, et al. Evaluation of district mental healthcare plans: the PRIME consortium methodology. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153858).Google Scholar
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