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      Evaluation of a new set of indicators for mental health care implemented in Madhya Pradesh, India: a mixed methods study

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          Abstract

          Background

          Mental health information systems are, in general, inadequate and unreliable in India. We have developed key mental health indicators for measuring mental health service coverage in primary care. This study aims to evaluate the use of these new indicators in seven health care facilities in Sehore District of Madhya Pradesh in India.

          Methods

          The study employed a mixed methods approach. We conducted: a qualitative study (n = 26) with health workers, Health Management Information Systems (HMIS) staff, project coordinators and supervisors; a review of case records (n = 61 at time 1 and n = 74 at time 2); and a structured questionnaire (n = 26) with health workers. The performance, user-friendliness, appropriateness, perceived utility and sustainability of the use of new mental health indicators was assessed.

          Results

          High levels of completion, and correctness of completion, of the new mental health indicators were found for the case records. The simplicity of the forms, as well as technical support from the project team, contributed to acceptability and feasibility of implementation. Perceived sustainability of the new forms was, however, affected by the overstretched primary care staff. Further work is needed to support the integration of mental health with routine HMIS.

          Conclusion

          This study demonstrated that the implementation of key mental health service delivery indicators in Sehore District primary care facilities was feasible. Technical assistance was imperative in maintaining the performance of the indicators over the two studied time points. The integration of mental health indicators in routine health information systems, and political buy-in, are needed to monitor and sustain community mental health programmes in India.

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          Most cited references 15

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          Grand Challenges in Global Mental Health: Integration in Research, Policy, and Practice

          In the first article of a five-part series providing a global perspective on integrating mental health, Pamela Collins and colleagues set the scene for why mental health care should be combined with priority programs on maternal and child health, non-communicable diseases, and HIV, and how this might be done.
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            Mental health initiatives in India (1947-2010).

             R Murthy (2015)
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              Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India

              Background The large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care. Aims To operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district. Method Mixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility. Results The MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment. Conclusions There are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models.
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                Author and article information

                Contributors
                shalini.ahuja@kcl.ac.uk
                azaz.khan@sangath.in
                lucy.goulding@kcl.ac.uk
                rachel.morrison@city.ac.uk
                rahulshidhaye@gmail.com
                graham.thornicroft@kcl.ac.uk
                mark.Jordans@kcl.ac.uk
                Journal
                Int J Ment Health Syst
                Int J Ment Health Syst
                International Journal of Mental Health Systems
                BioMed Central (London )
                1752-4458
                10 February 2020
                10 February 2020
                2020
                : 14
                Affiliations
                [1 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, , King’s College London, ; London, UK
                [2 ]GRID grid.471010.3, Programme for Improving Mental Health Care, ; Sangath, Bhopal India
                [3 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, , King’s College London, ; De Crespigny Park, London, SE5 8AF UK
                [4 ]GRID grid.28577.3f, ISNI 0000 0004 1936 8497, City, University of London, ; London, UK
                [5 ]GRID grid.415361.4, ISNI 0000 0004 1761 0198, Public Health Foundation of India, ; New Delhi, India
                Article
                341
                10.1186/s13033-020-0341-4
                7011241
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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                © The Author(s) 2020

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