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      Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India

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          Abstract

          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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          Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries

          Charlotte Hanlon, Nagendra P. Luitel, Tasneem Kathree … (2014)
          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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            Managing common mental health disorders in primary care: conceptual models and evidence base.

            Simon Gilbody, Peter Bower (2005)
            Article 0 comments Cited 68 times – based on 0 reviews     Review now
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              Short structured general mental health in service training programme in Kenya improves patient health and social outcomes but not detection of mental health problems - a pragmatic cluster randomised controlled trial

              Rachel Jenkins, Caleb Othieno, Stephen Okeyo … (2013)
              Trial design A pragmatic cluster randomised controlled trial. Methods Participants: Clusters were primary health care clinics on the Ministry of Health list. Clients were eligible if they were aged 18 and over. Interventions: Two members of staff from each intervention clinic received the training programme. Clients in both intervention and control clinics subsequently received normal routine care from their health workers. Objective: To examine the impact of a mental health inservice training on routine detection of mental disorder in the clinics and on client outcomes. Outcomes: The primary outcome was the rate of accurate routine clinic detection of mental disorder and the secondary outcome was client recovery over a twelve week follow up period. Randomisation: clinics were randomised to intervention and control groups using a table of random numbers. Blinding: researchers and clients were blind to group assignment. Results Numbers randomised: 49 and 50 clinics were assigned to intervention and control groups respectively. 12 GHQ positive clients per clinic were identified for follow up. Numbers analysed: 468 and 478 clients were followed up for three months in intervention and control groups respectively. Outcome: At twelve weeks after training of the intervention group, the rate of accurate routine clinic detection of mental disorder was greater than 0 in 5% versus 0% of the intervention and control groups respectively, in both the intention to treat analysis (p = 0.50) and the per protocol analysis (p =0.50). Standardised effect sizes for client improvement were 0.34 (95% CI = (0.01,0.68)) for the General Health Questionnaire, 0.39 ((95% CI = (0.22, 0.61)) for the EQ and 0.49 (95% CI = (0.11,0.87)) for WHODAS (using ITT analysis); and 0.43 (95% CI = (0.09,0.76)) for the GHQ, 0.44 (95% CI = (0.22,0.65)) for the EQ and 0.58 (95% CI = (0.18,0.97)) for WHODAS (using per protocol analysis). Harms: None identified. Conclusion The training programme did not result in significantly improved recorded diagnostic rates of mental disorders in the routine clinic consultation register, but did have significant effects on patient outcomes in routine clinical practice. Trial registration International Standard Randomised Controlled Trial Number Register ISRCTN53515024.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Psychiatry
                Journal ID (iso-abbrev): Br J Psychiatry
                Journal ID (hwp): bjprcpsych
                Title: The British Journal of Psychiatry
                Publisher: Royal College of Psychiatrists
                ISSN (Print): 0007-1250
                ISSN (Electronic): 1472-1465
                Publication date (Print): January 2016
                Publication date PMC-release: January 2016
                Volume: 208
                Issue: Suppl 56 , Mental health plans in five low- and middle-income countries: PRogramme for Improving Mental health carE (PRIME)
                Pages: s13-s20
                Affiliations
                Rahul Shidhaye, MD(Psych), MHS, Public Health Foundation of India, Bhopal, Madhya Pradesh, India, and CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands; Sanjay Shrivastava, MBBS, Vaibhav Murhar, MA(Psychol), PRIME project (India), Sangath, India; Sandesh Samudre, BAMS, MPH, Shalini Ahuja, MHMPP, BPT, Public Health Foundation of India; Rohit Ramaswamy, PhD, MPH, Grad.Dipl.(Bios), Public Health Leadership and Maternal and Child Health, University of North Carolina, Chapel Hill, North Carolina, USA and Adjunct Faculty, Public Health Foundation of India; Vikram Patel, MRCPsych, PhD, FMedSci, London School of Hygiene & Tropical Medicine, London, UK, Public Health Foundation of India and Sangath, India
                Author notes
                Correspondence: Rahul Shidhaye, Public Health Foundation of India, 19, Rishi Nagar, Char Imli, Bhopal, Madhya Pradesh, India. Email: rahul.shidhaye@ 123456phfi.org
                Article
                DOI: 10.1192/bjp.bp.114.153700
                PMC ID: 4698552
                PubMed ID: 26447172
                SO-VID: d7ae776b-a099-4f9d-a52b-cebf613ebb6c
                Copyright © © The Royal College of Psychiatrists 2016.
                License:

                This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

                History
                Date received : 1 July 2014
                Date revision received : 5 January 2015
                Date accepted : 15 January 2015
                Funding
                Funded by: UK aid from the UK government
                Funded by: Wellcome Trust
                Award Recipient :
                Categories
                Subject: Papers

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry

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