Integrating psychiatry into primary care: an experimental model

Mental health training for health workers in Africa: a systematic review

Commitment to building mental health treatment capacity in Africa is increasing but little agreement exists on strategies to train health workers on mental health or evaluation of training efforts. We systematically reviewed published literature on interventions to train health-care workers in Africa on mental health. 37 studies met our inclusion criteria. Training outcomes focused on changes in knowledge and attitude, with few studies evaluating skill and practice and only two studies measuring clinical outcomes. Quality of study methodology was generally not high, with scarce follow-up data and use of control cohorts. Existing studies provide examples of many training and evaluation strategies, but evidence to draw conclusions about the efficacy of different training techniques is inadequate. Key knowledge gaps include development and testing of innovative educational strategies; development of standardised, competency-based learning objectives and outcome measures; and training that facilitates implementation of integrated mental health systems. African institutions need to be empowered to do research in these areas to encourage the development of best practices for the continent.

Report of the Indo-US health care summit 2009 - Mental health section

The 2nd Indo-US Health Care Summit held in January 2009 was a forum to discuss collaboration between physicians in the US and India on medical education, health care services and research. Six specialties were represented including Mental Health (MH). Using Depression as the paradigmatic disorder, the following objectives were developed. Objective I - Leadership and Public Education: Linkage with like-minded agencies and organizations. The core message should be simple. Major Depression is a brain disorder. Depression is treatable. Timely treatment prevents disability and suicide. Objective II - Medical Education: To improve psychiatric education, it was proposed that (1) relations between US/UK and Indian mid-level institutions be established, (2) teaching methods such as tele-psychiatry and online courses be pursued, (3) use models of teaching excellence to arouse student interest, and (4) develop core curricula for other branches of medicine, and CME. Objective III - Reduce Complications of Depression (Suicide, Alcoholism): Goals include (1) decriminalizing attempted suicide, (2) improving reporting systems, and including depression, psychosis, alcoholism, and suicide in the national registry, (3) pilot studies in vulnerable groups on risk and interventions, and (4) education of colleagues on alcoholism as a link between psychiatric and medical disorders. Objective IV - Integrating MH Treatment& Primary Health Care: The focus should be on training of general practitioners in psychiatry. Available training modules including long distance learning modules to be suitably modified for India. Collaborations and specific project designs are to be developed, implemented and monitored by each specialty group and reviewed in future summits.

General practitioners' self-perceived ability to recognize severity of common mental disorders: an underestimated factor in case identification?

Background

Several studies have shown that general practitioners (GPs) under-diagnose common mental disorders, and that training courses hardly improve this practice. The influence of GPs' self-perceived ability to recognize the severity of such disorders on these facts has not been investigated. This study explores: 1) GPs' perceived ability to recognize major depressive episode (MDE) and generalized anxiety disorder (GAD) in their patients; 2) The GPs' observed ability to recognize severity of these disorders; and 3) If the observed ability to recognize severity is associated with their perceived ability.

Methods

In a cross-sectional design 40 Norwegian GPs examined 15 – 28 patients each (total N = 724). The GPs' rated their perceived ability to recognize MDE and GAD on a four-point Likert-scale. The GPs' observed ability to recognize severity was defined as the mean of the correlations between the GPs rating of Clinical Global Impression-Severity Scale and the diagnostic reference standards for MDE and GAD filled in by patients.

Results

Twenty-two GPs considered their perceived ability to recognize MDE as rather good, and the other 18 as moderate/bad. For GAD 12 GPs' perceived their ability as rather good, while 28 considered their ability to be moderate/bad. The observed ability to recognize severity concerning MDE was 0.63 and concerning GAD 0.45. There was no significant association between GPs' perceived and observed abilities to recognize MDE (p = 0.19) and GAD (p = 0.34)

Conclusion

This study found a discrepancy between the GPs' perceived and observed ability to recognize common mental disorders. The lack of association between GPs' perceived and observed ability to recognize such disorders indicate low understanding of own recognition abilities. This might contribute to explain the low effectiveness of interventions aimed to increase GPs' abilities to recognize mental disorders.