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McDaid D, Vidyasagaran AL, Nasir M, Walker S, Wright J, Muliyala KP, Thekkumkara S, Huque R, Faisal MR, Benkalkar S, Kabir MA, Russell C, Siddiqi N. Understanding the costs and economic impact of mental disorders in South Asia: A systematic review. Asian J Psychiatr 2024; 102:104239. [PMID: 39332059 DOI: 10.1016/j.ajp.2024.104239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/11/2024] [Accepted: 09/05/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Mental disorders remain the most significant contributor to years lived with disability in South Asia, yet governmental health expenditure on mental health in South Asia remains very low with limited strategic policy development. To strengthen the case for action it is important to better understand the profound economic costs associated with poor mental health. METHODS We conducted a systematic review on the costs of all mental disorders, as well as intentional self-harm and suicide, in the World Bank South Asia Region. Ten global and South Asian databases as well as grey literature sources were searched. RESULTS 72 studies were identified, including 38 meeting high quality criteria for good reporting of costs. Of these, 27 covered India, five Pakistan, four Nepal and three Bangladesh and Sri Lanka. Most studies focused on depressive disorders (15), psychoses (14) and harmful alcohol use (7); knowledge of economic impacts for other conditions was limited. Profound economic impacts within and beyond health care systems were found. In 15 of 18 studies which included productivity losses to individuals and/or carers, these costs more than outweighed costs of health care. CONCLUSION Mental disorders represent a considerable economic burden, but existing estimates are conservative as they do not consider long-term impacts or the full range of conditions. Modelling studies could be employed covering longer time periods and more conditions. Clear distinctions should be reported between out-of-pocket and health system costs, as well as between mental health service-specific and physical health-related costs.
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Affiliation(s)
- David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK.
| | | | - Muhammed Nasir
- Department of Economics, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bengaluru, India
| | | | | | | | | | | | - Claire Russell
- Metro North Hospital and Health Service, Queensland, Australia
| | - Najma Siddiqi
- Department of Health Sciences and Hull York Medical School (HYMS), York, UK; Bradford District Care NHS Foundation Trust (BDCFT), Bradford, UK
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Ibragimov K, Keane GP, Carreño Glaría C, Cheng J, Llosa AE. Haloperidol (oral) versus olanzapine (oral) for people with schizophrenia and schizophrenia-spectrum disorders. Cochrane Database Syst Rev 2024; 7:CD013425. [PMID: 38958149 PMCID: PMC11220909 DOI: 10.1002/14651858.cd013425.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Schizophrenia is often a severe and disabling psychiatric disorder. Antipsychotics remain the mainstay of psychotropic treatment for people with psychosis. In limited resource and humanitarian contexts, it is key to have several options for beneficial, low-cost antipsychotics, which require minimal monitoring. We wanted to compare oral haloperidol, as one of the most available antipsychotics in these settings, with a second-generation antipsychotic, olanzapine. OBJECTIVES To assess the clinical benefits and harms of haloperidol compared to olanzapine for people with schizophrenia and schizophrenia-spectrum disorders. SEARCH METHODS We searched the Cochrane Schizophrenia study-based register of trials, which is based on monthly searches of CENTRAL, CINAHL, ClinicalTrials.gov, Embase, ISRCTN, MEDLINE, PsycINFO, PubMed and WHO ICTRP. We screened the references of all included studies. We contacted relevant authors of trials for additional information where clarification was required or where data were incomplete. The register was last searched on 14 January 2023. SELECTION CRITERIA Randomised clinical trials comparing haloperidol with olanzapine for people with schizophrenia and schizophrenia-spectrum disorders. Our main outcomes of interest were clinically important change in global state, relapse, clinically important change in mental state, extrapyramidal side effects, weight increase, clinically important change in quality of life and leaving the study early due to adverse effects. DATA COLLECTION AND ANALYSIS We independently evaluated and extracted data. For dichotomous outcomes, we calculated risk ratios (RR) and their 95% confidence intervals (CI) and the number needed to treat for an additional beneficial or harmful outcome (NNTB or NNTH) with 95% CI. For continuous data, we estimated mean differences (MD) or standardised mean differences (SMD) with 95% CIs. For all included studies, we assessed risk of bias (RoB 1) and we used the GRADE approach to create a summary of findings table. MAIN RESULTS We included 68 studies randomising 9132 participants. We are very uncertain whether there is a difference between haloperidol and olanzapine in clinically important change in global state (RR 0.84, 95% CI 0.69 to 1.02; 6 studies, 3078 participants; very low-certainty evidence). We are very uncertain whether there is a difference between haloperidol and olanzapine in relapse (RR 1.42, 95% CI 1.00 to 2.02; 7 studies, 1499 participants; very low-certainty evidence). Haloperidol may reduce the incidence of clinically important change in overall mental state compared to olanzapine (RR 0.70, 95% CI 0.60 to 0.81; 13 studies, 1210 participants; low-certainty evidence). For every eight people treated with haloperidol instead of olanzapine, one fewer person would experience this improvement. The evidence suggests that haloperidol may result in a large increase in extrapyramidal side effects compared to olanzapine (RR 3.38, 95% CI 2.28 to 5.02; 14 studies, 3290 participants; low-certainty evidence). For every three people treated with haloperidol instead of olanzapine, one additional person would experience extrapyramidal side effects. For weight gain, the evidence suggests that there may be a large reduction in the risk with haloperidol compared to olanzapine (RR 0.47, 95% CI 0.35 to 0.61; 18 studies, 4302 participants; low-certainty evidence). For every 10 people treated with haloperidol instead of olanzapine, one fewer person would experience weight increase. A single study suggests that haloperidol may reduce the incidence of clinically important change in quality of life compared to olanzapine (RR 0.72, 95% CI 0.57 to 0.91; 828 participants; low-certainty evidence). For every nine people treated with haloperidol instead of olanzapine, one fewer person would experience clinically important improvement in quality of life. Haloperidol may result in an increase in the incidence of leaving the study early due to adverse effects compared to olanzapine (RR 1.99, 95% CI 1.60 to 2.47; 21 studies, 5047 participants; low-certainty evidence). For every 22 people treated with haloperidol instead of olanzapine, one fewer person would experience this outcome. Thirty otherwise relevant studies and several endpoints from 14 included studies could not be evaluated due to inconsistencies and poor transparency of several parameters. Furthermore, even within studies that were included, it was often not possible to use data for the same reasons. Risk of bias differed substantially for different outcomes and the certainty of the evidence ranged from very low to low. The most common risks of bias leading to downgrading of the evidence were blinding (performance bias) and selective reporting (reporting bias). AUTHORS' CONCLUSIONS Overall, the certainty of the evidence was low to very low for the main outcomes in this review, making it difficult to draw reliable conclusions. We are very uncertain whether there is a difference between haloperidol and olanzapine in terms of clinically important global state and relapse. Olanzapine may result in a slightly greater overall clinically important change in mental state and in a clinically important change in quality of life. Different side effect profiles were noted: haloperidol may result in a large increase in extrapyramidal side effects and olanzapine in a large increase in weight gain. The drug of choice needs to take into account side effect profiles and the preferences of the individual. These findings and the recent inclusion of olanzapine alongside haloperidol in the WHO Model List of Essential Medicines should increase the likelihood of it becoming more easily available in low- and middle- income countries, thereby improving choice and providing a greater ability to respond to side effects for people with lived experience of schizophrenia. There is a need for additional research using appropriate and equivalent dosages of these drugs. Some of this research needs to be done in low- and middle-income settings and should actively seek to account for factors relevant to these. Research on antipsychotics needs to be person-centred and prioritise factors that are of interest to people with lived experience of schizophrenia.
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Affiliation(s)
- Khasan Ibragimov
- Ecole des Hautes Etudes en Sante Publique (EHESP), Hautes Etudes en Sante Publique (EHESP), Paris, France
- Epicentre, Paris, France
| | | | | | - Jie Cheng
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Augusto Eduardo Llosa
- Epicentre, Paris, France
- Operational Centre Barcelona, Médecins Sans Frontières, Barcelona, Spain
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Desrosiers A, Carrol B, Ritsema H, Higgins W, Momoh F, Betancourt TS. Advancing sustainable implementation of an evidence-based mental health intervention in Sierra Leone's schools: protocol for a hybrid type 3 implementation-effectiveness trial. BMC Public Health 2024; 24:362. [PMID: 38310232 PMCID: PMC10837990 DOI: 10.1186/s12889-024-17928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Mental health disorders among youth contribute substantially to the global burden of disease, which is exacerbated in low- and middle-income countries (LMICs) due to large mental health treatment gaps. In Sierra Leone, a West African country with a long history of complex adversity, the mental health treatment gap is estimated at 98%. Implementing innovative mental health interventions that can be sustained at scale is a priority. The Youth Readiness Intervention (YRI) is an evidence-based mental health intervention for youth that can be delivered feasibly by lay health workers/nonspecialists. Using mobile-based technologies to assist implementation could improve the reach and sustainability of the YRI in Sierra Leone. This study aims to train teachers to deliver the YRI in Sierra Leone's secondary schools and test the feasibility, acceptability, cost, and fidelity to the YRI of a mobile-based supervision model compared with standard, in-person supervision. METHODS We will conduct a hybrid type 3 implementation-effectiveness cluster randomized trial to assess the feasibility, acceptability, costs and fidelity to the YRI implemented by teachers receiving mobile-based supervision vs. standard supervision. Enrolled schools (N = 50) will be randomized to YRI + mobile supervision (N = 20), YRI + standard supervision (N = 20) or waitlist control (N = 10). We will recruit and enroll four teachers per intervention-condition school (N = 160) and 1200 youth. We will collect data on implementation outcomes among teachers, principals and youth via a mixed methods approach at baseline and post-intervention. We will also collect quantitative data on youth mental health and functioning as secondary outcomes at baseline and post-intervention, as well as cost-effectiveness data at 12-month follow-up. DISCUSSION Study findings have the potential to expand the reach of mental health services among youth in low-resource settings via a teacher workforce. The use of mobile tools, if successful, could support further scale out and sustainment of the YRI to other regions of Sierra Leone and West Africa more broadly, which could help address the mental health treatment gap. TRIAL REGISTRATION Clinical Trial Network: NCT05737667.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA.
| | - Bidemi Carrol
- RTI International, 701 13th St NW #750, Washington, DC, 20005, USA
| | - Haley Ritsema
- Department of Psychiatry and Human Behavior, Brown University, Warren Alport Medical School, 345 Blackstone Blvd Providence, Providence, RI, 02906, USA
| | - Walker Higgins
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Fatoma Momoh
- Innovations For Poverty Action, 47A&B Johnson Street, Freetown, Sierra Leone
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02496, USA
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Desrosiers A, Schafer C, Bond L, Akinsulure-Smith A, Hinton M, Vandi A, Betancourt TS. Exploring potential mental health spillover effects among caregivers and partners of youth in Sierra Leone: A qualitative study. Glob Ment Health (Camb) 2023; 10:e40. [PMID: 37854398 PMCID: PMC10579673 DOI: 10.1017/gmh.2023.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/20/2023] [Accepted: 07/07/2023] [Indexed: 10/20/2023] Open
Abstract
Given the large mental health treatment gap in low- and middle-income countries (LMICs), particularly in post-conflict settings like Sierra Leone, and the limited healthcare infrastructure, understanding the wider benefits of evidence-based mental health interventions within households is critical. This study explored potential mental health spillover effects - the phenomenon of beneficial effects among nonparticipants - among cohabitating caregivers and partners of youth who participated in an evidence-based mental health intervention in Sierra Leone. We recruited a sub-sample of cohabitating caregivers and partners (N = 20) of youth intervention participants; caregivers had enrolled in a larger study investigating indirect benefits of the evidence-based intervention in Sierra Leone (MH117359). Qualitative interviews were conducted at two time points to explore the following: (a) potential mental health spillover effects and (b) through which mechanisms spillover may have occurred. Two trained coders reviewed transcripts and analyzed qualitative data, assisted by MaxQDA. Qualitative findings suggested that spillover effects likely occurred and supported three potential mechanisms: decreased caregiving burden, behavior changes among Youth Readiness Intervention participants and improved interpersonal relationships. Mental health spillover effects may occur following youth intervention participation in a post-conflict LMIC. Investing in evidence-based services may offer indirect benefits that extend beyond those directly receiving services.
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Affiliation(s)
- Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Carolyn Schafer
- Institute for Public Health and Medicine, Northwestern University, Evanston, IL, USA
| | - Laura Bond
- Boston College School of Social Work, Chestnut Hill, MA, USA
| | | | | | - Alpha Vandi
- Caritas Sierra Leone, Freetown, Sierra Leone
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Stelmach R, Kocher EL, Kataria I, Jackson-Morris AM, Saxena S, Nugent R. The global return on investment from preventing and treating adolescent mental disorders and suicide: a modelling study. BMJ Glob Health 2022; 7:e007759. [PMID: 35705224 PMCID: PMC9240828 DOI: 10.1136/bmjgh-2021-007759] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/02/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Despite the high burden of mental disorders among adolescents and the potentially lifelong consequences of these conditions, access to mental health services remains insufficient for adolescents in low-income and middle-income countries. We conducted an economic modelling study to quantify the potential costs and benefits of mental health interventions to prevent or treat anxiety, depression, bipolar disorder, and suicide among adolescents. METHODS We developed a Markov model that followed cohorts of adolescents (ages 10-19) from 36 countries to assess the impact of addressing anxiety, depression, bipolar disorder, and suicide during adolescence on health and non-health outcomes through their lives. We estimated the costs of interventions using an ingredients-based approach and modelled impacts on education and employment and the resulting economic, morbidity, and mortality benefits. RESULTS Implementing the selected interventions offers a return on investment of 23.6 and a cost of $102.9 per disability adjusted life year (DALY) averted over 80 years. The high return on investment and low cost per DALY averted is observed across regions and country income levels, with the highest return on investment arising from treating mild depression with group-based cognitive behavioural therapy, prevention of suicide attempts among high-risk adolescents, and universal prevention of combined anxiety and depression in low-income and lower-middle income countries. CONCLUSIONS The high return on investment and low cost per DALY averted suggests the importance and value of addressing mental disorders among adolescents worldwide. Intervening to prevent and treat these mental disorders even only during adolescence can have lifelong health and economic benefits.
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Affiliation(s)
- Rachel Stelmach
- International Development Group, RTI International, Washington, District of Columbia, USA
| | - Erica L Kocher
- Center for Global NCDs, RTI International, Research Triangle Park, North Carolina, USA
| | - Ishu Kataria
- Center for Global NCDs, RTI International, Research Triangle Park, North Carolina, USA
| | | | - Shekhar Saxena
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel Nugent
- Center for Global NCDs, RTI International, Research Triangle Park, North Carolina, USA
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Cost-effectiveness of psychological intervention within services for depression delivered by primary care workers in Nepal: economic evaluation of a randomized control trial. Glob Ment Health (Camb) 2022; 9:499-507. [PMID: 36618735 PMCID: PMC9806977 DOI: 10.1017/gmh.2022.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Integrating services for depression into primary care is key to reducing the treatment gap in low- and middle-income countries. We examined the value of providing the Healthy Activity Programme (HAP), a behavioral activation psychological intervention, within services for depression delivered by primary care workers in Chitwan, Nepal using data from the Programme for Improving Mental Health Care. METHODS People diagnosed with depression were randomized to receive either standard treatment (ST), comprised of psychoeducation, antidepressant medication, and home-based follow up, or standard treatment plus psychological intervention (T + P). We estimated incremental costs and health effects of T + P compared to ST, with quality adjusted life years (QALYs) and depression symptom scores over 12 months as health effects. Nonparametric uncertainty analysis provided confidence intervals around each incremental effectiveness ratio (ICER); results are presented in 2020 international dollars. RESULTS Sixty participants received ST and 60 received T + P. Implementation costs (ST = $329, T + P = $617) were substantially higher than service delivery costs (ST = $18.7, T + P = $22.4) per participant. ST and T + P participants accrued 46.5 and 49.4 QALYs, respectively. The ICERs for T + P relative to ST were $4422 per QALY gained (95% confidence interval: $2484 to $9550) - slightly above the highly cost-effective threshold - and -$53.21 (95% confidence interval: -$105.8 to -$30.2) per unit change on the Patient Health Questionnaire. CONCLUSION Providing HAP within integrated depression services in Chitwan was cost-effective, if not highly cost-effective. Efforts to scale up integrated services in Nepal and similar contexts should consider including evidence-based psychological interventions as a part of cost-effective mental healthcare for depression.
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Seward N, Hanlon C, Hinrichs-Kraples S, Lund C, Murdoch J, Taylor Salisbury T, Verhey R, Shidhaye R, Thornicroft G, Araya R, Sevdalis N. A guide to systems-level, participatory, theory-informed implementation research in global health. BMJ Glob Health 2021; 6:e005365. [PMID: 34969685 PMCID: PMC8718460 DOI: 10.1136/bmjgh-2021-005365] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/03/2021] [Indexed: 12/17/2022] Open
Abstract
Implementation research is a multidisciplinary field that addresses the complex phenomenon of how context influences our ability to deliver evidence-informed healthcare. There is increasing realisation of the importance of applying robust implementation research to scale-up life-saving interventions that meet health-related sustainable development goals. However, the lack of high-quality implementation research is impeding our ability to meet these targets, globally. Within implementation research, theory refers to the proposed hypothesis and/or explanation of how an intervention is expected to interact with the local context and actors to bring about change. Although there is increasing interest in applying theory to understand how and why implementation programmes work in real-world settings, global health actors still tend to favour impact evaluations conducted in controlled environments. This may, in part, be due to the relative novelty as well as methodological complexity of implementation research and the need to draw on divergent disciplines, including epidemiology, implementation science and social sciences. Because of this, implementation research is faced with a particular set of challenges about how to reconcile different ways of thinking and constructing knowledge about healthcare interventions. To help translate some of the ambiguity surrounding how divergent theoretical approaches and methods contribute to implementation research, we draw on our multidisciplinary expertise in the field, particularly in global health. We offer an overview of the different theoretical approaches and describe how they are applied to continuously select, monitor and evaluate implementation strategies throughout the different phases of implementation research. In doing so, we offer a relatively brief, user-focused guide to help global health actors implement and report on evaluation of evidence-based and scalable interventions, programmes and practices.
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Affiliation(s)
- Nadine Seward
- Centre for Implementation Science, Department of Health Service and Population Research, King's College London, London, UK
| | - Charlotte Hanlon
- Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Crick Lund
- King's College London, London, UK
- University of Cape Town, Rondebosch, South Africa
| | - Jamie Murdoch
- University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK
| | | | - Ruth Verhey
- Research Support Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | | | | | - Nick Sevdalis
- Health Service & Population Research Department, King's College London, London, UK
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Kretchy IA, Blewuada EK, Debrah AB. A qualitative study exploring community pharmacists’ perspectives of child and adolescent mental healthcare. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mukala Mayoyo E, van de Put W, Van Belle S, van Mierlo B, Criel B. Intégration de la santé mentale dans les services de soins de santé primaires en République démocratique du Congo. SANTE PUBLIQUE 2021; Vol. 33:77-87. [PMID: 34372645 DOI: 10.3917/spub.211.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The study aims to document the experience of integrating a mental health care package into the general health care system of Lubero district in the Democratic Republic of Congo (DRC) between 2011 and 2015, and more specifically, the effects of this integration on the access to and use of health services offering mental health care. METHOD This is a retrospective study using a case study design. Data collected from different project documents and an analytic review of the official reports of the Ministry of Public Health were used for an analysis of the results of the integration. RESULTS The results indicate that 3,941 patients with mental health problems used the care offered at the health centers and the district hospital between 2012 and 2015. In 2015, the average utilization rate of curative care in health centers for mental health problems was 7 new cases/1,000 inhabitants/year. The majority of these patients were treated on an outpatient basis, at primary health care level. DISCUSSION Our study shows that it is possible to integrate mental health into existing general health services in the DRC. Nevertheless, the major problems in terms of access and use of basic care in the Lubero district indicate that the success of such an integration depends on the quality of the health system in place and the involvement of a wide range of both health and non-health actors, including key people within communities.
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Wainberg ML, Lovero KL, Duarte CS, Fiks Salem A, Mello M, Bezuidenhout C, Mootz J, Feliciano P, Suleman A, Fortunato Dos Santos P, Weissman MM, Cournos F, Marques AH, Fumo W, Mabunda D, Alves-Bradford JME, Mello M, Mari JJ, Ngwepe P, Cidav Z, Mocumbi AO, Medina-Marino A, Wall M, Gouveia L, Oquendo MA. Partnerships in Research to Implement and Disseminate Sustainable and Scalable Evidence-Based Practices (PRIDE) in Mozambique. Psychiatr Serv 2021; 72:802-811. [PMID: 33334157 PMCID: PMC8211906 DOI: 10.1176/appi.ps.202000090] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mental health conditions impose a major burden worldwide, especially in low- and middle-income countries (LMICs), where health specialists are scarce. A challenge to closing LMICs' mental health treatment gap is determining the most cost-effective task-shifting pathway for delivering mental health services using evidence-based interventions (EBIs). This article discusses the protocol for the first study implementing comprehensive mental health services in LMICs. METHODS In partnership with the Mozambican Ministry of Health, this cluster-randomized, hybrid implementation effectiveness type-2 trial will evaluate implementation, patient, and service outcomes of three task-shifting delivery pathways in 20 Mozambican districts (population 4.7 million). In pathway 1 (usual care), community health workers (CHWs) and primary care providers (PCPs) refer patients to district-level mental health clinics. In pathway 2 (screen, refer, and treat), CHWs screen and refer patients to PCPs for behavioral and pharmacological EBIs in community clinics. In pathway 3 (community mental health stepped care), CHWs screen patients and deliver behavioral EBIs in the community and refer medication management cases to PCPs in clinics. Mixed-methods process evaluation will be used to examine factors affecting pathway implementation, adoption, and sustainability. Clinical activities will occur without research team support. Ministry of Health personnel will coordinate training and supervision. RESULTS The most cost-effective pathway will be scaled up in all districts for 12 months. NEXT STEPS This novel study integrating comprehensive mental health services into primary care will inform a toolkit to help the Mozambican Ministry of Health scale up the most cost-effective pathway for mental health services and can be a template for other LMICs.
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Affiliation(s)
- Milton L Wainberg
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Kathryn L Lovero
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Cristiane S Duarte
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Andre Fiks Salem
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Milena Mello
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Charl Bezuidenhout
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Jennifer Mootz
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Paulino Feliciano
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Antonio Suleman
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Palmira Fortunato Dos Santos
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Myrna M Weissman
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Francine Cournos
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Andrea Horvath Marques
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Wilza Fumo
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Dirceu Mabunda
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Jean-Marie E Alves-Bradford
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Marcelo Mello
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Jair J Mari
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Phuti Ngwepe
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Zuleyha Cidav
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Ana Olga Mocumbi
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Andrew Medina-Marino
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Melanie Wall
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Lidia Gouveia
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
| | - Maria A Oquendo
- Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City (Wainberg, Lovero, Duarte, Fiks Salem, Milena Mello, Mootz, Weissman, Cournos, Alves-Bradford, Wall); Research Unit, Foundation for Professional Development, Pretoria, South Africa (Bezuidenhout, Ngwepe, Medina-Marino); Hospital Psiquiatrico Nampula, Nampula, Mozambique (Feliciano, Suleman); Mental Health Department, Ministry of Health, Maputo, Mozambique (Fortunato dos Santos, Fumo, Mocumbi, Gouveia); National Institute of Mental Health (NIMH), Bethesda, Maryland (Marques); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (Mabunda, Mocumbi); Department of Psychobiology and Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo, Brazil (Marcelo Mello, Mari); Department of Psychiatry and Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Cidav, Oquendo)
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Hosseini Jebeli SS, Rezapour A, Hajebi A, Moradi-Lakeh M, Damari B. Scaling-up a new socio-mental health service model in Iran to reduce burden of neuropsychiatric disorders: an economic evaluation study. Int J Ment Health Syst 2021; 15:47. [PMID: 34016121 PMCID: PMC8139035 DOI: 10.1186/s13033-021-00468-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 05/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs. METHODS This study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of drug and supply, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case. RESULTS The health impacts are calculated in terms of healthy life years gained for 2020-2030, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in base case scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5550 US dollars for Iran in 2018. CONCLUSIONS Mental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly. The present study demonstrated that the cost in this new socio-mental services model is not substantial compared with GDP per capita of Iran.
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Affiliation(s)
- Seyede Sedighe Hosseini Jebeli
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Ahmad Hajebi
- Research Center for Addiction and Risky Behavior (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Department of Community and Family Medicine, Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Behzad Damari
- Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Chisholm D, Garman E, Breuer E, Fekadu A, Hanlon C, Jordans M, Kathree T, Kigozi F, Luitel N, Medhin G, Murhar V, Petersen I, Rathod SD, Shidhaye R, Ssebunnya J, Patel V, Lund C. Health service costs and their association with functional impairment among adults receiving integrated mental health care in five low- and middle-income countries: the PRIME cohort study. Health Policy Plan 2020; 35:567-576. [PMID: 32150273 PMCID: PMC11318687 DOI: 10.1093/heapol/czz182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2019] [Indexed: 11/12/2022] Open
Abstract
This study examines the level and distribution of service costs-and their association with functional impairment at baseline and over time-for persons with mental disorder receiving integrated primary mental health care. The study was conducted over a 12-month follow-up period in five low- and middle-income countries participating in the Programme for Improving Mental health carE study (Ethiopia, India, Nepal, South Africa and Uganda). Data were drawn from a multi-country intervention cohort study, made up of adults identified by primary care providers as having alcohol use disorders, depression, psychosis and, in the three low-income countries, epilepsy. Health service, travel and time costs, including any out-of-pocket (OOP) expenditures by households, were calculated (in US dollars for the year 2015) and assessed at baseline as well as prospectively using linear regression for their association with functional impairment. Cohort samples were characterized by low levels of educational attainment (Ethiopia and Uganda) and/or high levels of unemployment (Nepal, South Africa and Uganda). Total health service costs per case for the 3 months preceding baseline assessment averaged more than US$20 in South Africa, $10 in Nepal and US$3-7 in Ethiopia, India and Uganda; OOP expenditures ranged from $2 per case in India to $16 in Ethiopia. Higher service costs and OOP expenditure were found to be associated with greater functional impairment in all five sites, but differences only reached statistical significance in Ethiopia and India for service costs and India and Uganda for OOP expenditure. At the 12-month assessment, following initiation of treatment, service costs and OOP expenditure were found to be lower in Ethiopia, South Africa and Uganda, but higher in India and Nepal. There was a pattern of greater reduction in service costs and OOP spending for those whose functional status had improved in all five sites, but this was only statistically significant in Nepal.
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Affiliation(s)
- Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health
Organization, Avenue Appia 20, Geneva 1211, Switzerland
| | - Emily Garman
- Alan J Flisher Centre for Public Mental Health, Department of
Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700
Cape Town, South Africa
| | - Erica Breuer
- Alan J Flisher Centre for Public Mental Health, Department of
Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700
Cape Town, South Africa
| | - Abebaw Fekadu
- Centre for Global Mental Health, Health Service and
Population Research Department, Institute of Psychiatry, Psychology & Neuroscience,
King’s College London, De Crespigny Park, SE5, London, UK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and
Population Research Department, Institute of Psychiatry, Psychology & Neuroscience,
King’s College London, De Crespigny Park, SE5, London, UK
- Department of Psychiatry, School of Medicine, College of
Health Sciences, Addis Ababa University, Arat Kilo, 1176, Addis Ababa, Ethiopia
| | - Mark Jordans
- Centre for Global Mental Health, Health Service and
Population Research Department, Institute of Psychiatry, Psychology & Neuroscience,
King’s College London, De Crespigny Park, SE5, London, UK
| | - Tasneem Kathree
- School of Psychology, University of KwaZulu Natal, Umbilo
Road, Congella 4013, Durban, South Africa
| | - Fred Kigozi
- Butabika Mental Hospital, Plot 2, Butabika Road, P.O. Box
7017, Kampala, Uganda
| | - Nagendra Luitel
- Transcultural Psychosocial Organization (TPO) Nepal,
Baluwatar 44600, Kathmandu, Nepal
| | - Girmay Medhin
- Department of Psychiatry, School of Medicine, College of
Health Sciences, Addis Ababa University, Arat Kilo, 1176, Addis Ababa, Ethiopia
| | - Vaibhav Murhar
- Sangath, 120, Deepak Society, Chuna Bhatti, Bhopal, Madhya
Pradesh 462016, India
| | - Inge Petersen
- School of Psychology, University of KwaZulu Natal, Umbilo
Road, Congella 4013, Durban, South Africa
| | - Sujit D Rathod
- Department of Population Health, London School of Hygiene and
Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rahul Shidhaye
- Centre for Mental Health, Public Health Foundation of India,
Unit No. 316, 3rd Floor, Rectangle -1 Building, Plot No. D-4, District Centre Saket, New
Delhi-110017, India
| | - Joshua Ssebunnya
- Butabika Mental Hospital, Plot 2, Butabika Road, P.O. Box
7017, Kampala, Uganda
| | - Vikram Patel
- Centre for Mental Health, Public Health Foundation of India,
Unit No. 316, 3rd Floor, Rectangle -1 Building, Plot No. D-4, District Centre Saket, New
Delhi-110017, India
- Department of Global Health and Social Medicine, Harvard
Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of
Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700
Cape Town, South Africa
- Centre for Global Mental Health, Health Service and
Population Research Department, Institute of Psychiatry, Psychology & Neuroscience,
King’s College London, De Crespigny Park, SE5, London, UK
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13
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Desrosiers A, Kumar P, Dayal A, Alex L, Akram A, Betancourt T. Diffusion and spillover effects of an evidence-based mental health intervention among peers and caregivers of high risk youth in Sierra Leone: study protocol. BMC Psychiatry 2020; 20:85. [PMID: 32103730 PMCID: PMC7045441 DOI: 10.1186/s12888-020-02500-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based mental health interventions have helped address health services gaps, but their reach and societal benefit can be limited in low resource settings. The current study extends an ongoing scale-up study of a cognitive behavioral therapy (CBT)-based intervention, the Youth Readiness Intervention (YRI), among high risk youth in post-conflict Sierra Leone to investigate mechanisms of diffusion and spillover effects of the YRI among peers and caregivers of youth who receive the intervention. METHODS We will recruit and enroll YRI index participants and control index participants (ages 18-30). Index participants will complete a standardized ego-network survey to nominate three peers in their social networks and identify their primary cohabitating caregiver. Identified peers and caregivers who consent to participate will complete a quantitative assessment battery on mental health outcomes, emotion regulation, and daily functioning at baseline and 8-month follow-up. Study outcomes also incorporate common indicators for implementation science, including measures of project context, evaluation, and scaleup. Social network analysis will investigate diffusion of YRI components across peer networks. Linear growth modeling will examine mental health spillover effects among caregivers. Incremental health costs and benefits among YRI participants' caregivers and peers will be assessed through cost-effectiveness and return on investment analysis. DISCUSSION Assessing implementation research outcomes, including penetration of YRI effects across social networks and cost-effectiveness of the YRI as distinct outcomes, will provide key information about the success of YRI implementation. Lessons learned could inform decisions to increase scale up efforts in Sub-Saharan Africa and other low resource settings.
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Affiliation(s)
- Alethea Desrosiers
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Praveen Kumar
- grid.208226.c0000 0004 0444 7053Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA
| | - Arja Dayal
- Innovations for Poverty Action, 40 Wilkinson Road, Freetown, Sierra Leone
| | - Leslie Alex
- Innovations for Poverty Action, 40 Wilkinson Road, Freetown, Sierra Leone
| | - Ali Akram
- Innovations for Poverty Action, 40 Wilkinson Road, Freetown, Sierra Leone
| | - Theresa Betancourt
- grid.208226.c0000 0004 0444 7053Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA
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14
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Breuer E, Hanlon C, Bhana A, Chisholm D, Silva MD, Fekadu A, Honikman S, Jordans M, Kathree T, Kigozi F, Luitel NP, Marx M, Medhin G, Murhar V, Ndyanabangi S, Patel V, Petersen I, Prince M, Raja S, Rathod SD, Shidhaye R, Ssebunnya J, Thornicroft G, Tomlinson M, Wolde-Giorgis T, Lund C. Partnerships in a Global Mental Health Research Programme-the Example of PRIME. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2019; 6:159-175. [PMID: 31984205 PMCID: PMC6980236 DOI: 10.1007/s40609-018-0128-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Collaborative research partnerships are necessary to answer key questions in global mental health, to share expertise, access funding and influence policy. However, partnerships between low- and middle-income countries (LMIC) and high-income countries have often been inequitable with the provision of technical knowledge flowing unilaterally from high to lower income countries. We present the experience of the Programme for Improving Mental Health Care (PRIME), a LMIC-led partnership which provides research evidence for the development, implementation and scaling up of integrated district mental healthcare plans in Ethiopia, India, Nepal, South Africa and Uganda. We use Tuckman's first four stages of forming, storming, norming and performing to reflect on the history, formation and challenges of the PRIME Consortium. We show how this resulted in successful partnerships in relation to management, research, research uptake and capacity building and reflect on the key lessons for future partnerships.
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Affiliation(s)
- Erica Breuer
- Alan J. Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Arvin Bhana
- South African Medical Research Council, Durban, South Africa
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Dan Chisholm
- Regional Office for Europe, World Health Organisation, Copenhagen, Denmark
| | | | - Abebaw Fekadu
- CDT-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Brighton and Sussex Medical School, Brighton, UK
| | - Simone Honikman
- Perinatal Mental Health Project, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Jordans
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Tasneem Kathree
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Fred Kigozi
- School of Medicine, Makerere University, Kampala, Uganda
| | | | - Maggie Marx
- Alan J. Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Inge Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Martin Prince
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | | | - Sujit D. Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Mark Tomlinson
- Alan J. Flisher Centre for Public Mental Health, Stellenbosch University, Stellenbosch, South Africa
| | | | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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Thornicroft G, Semrau M. Health system strengthening for mental health in low- and middle-income countries: introduction to the Emerald programme. BJPsych Open 2019; 5:e66. [PMID: 31685066 PMCID: PMC6688463 DOI: 10.1192/bjo.2019.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 01/09/2023] Open
Abstract
This paper gives an overview of the Emerald (Emerging mental health systems in low- and middle-income countries) programme and introduces the subsequent seven papers in this BJPsych Open thematic series. The aims of the Emerald research programme were to improve mental health outcomes in six low- and middle-income countries (LMICs), namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda, by building capacity and by generating evidence to enhance health system strengthening in these six countries. The longer-term aim is to improve mental healthcare, and so contribute to a reduction in the large treatment gap that exists for mental disorders. This series includes papers describing the following components of the Emerald programme: (a) capacity building; (b) mental health financing; (c) integrated care (d) mental health information systems; and (e) knowledge transfer. We also include a cross-cutting paper with recommendations from the Emerald programme as a whole. The inclusion of clear mental-health-related targets and indicators within the United Nations Sustainable Development Goals now intensifies the need for strong evidence about both how to provide effective treatments, and how to deliver these treatments within robust health systems.
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Affiliation(s)
- Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Maya Semrau
- Research Fellow in Implementation Research, Centre for Global Health Research, Brighton and Sussex Medical School; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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16
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Minoletti A, Sepúlveda R, Gómez M, Toro O, Irarrázabal M, Díaz R, Hernández V, Chacón S. [Analysis of Governance in the Implementation of the Chilean Community Mental Health ModelAnálise da governança na implementação do modelo comunitário de saúde mental no Chile]. Rev Panam Salud Publica 2019; 42:e131. [PMID: 31093159 PMCID: PMC6386069 DOI: 10.26633/rpsp.2018.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/12/2018] [Indexed: 12/03/2022] Open
Abstract
El presente artículo describe y analiza el rol que ha jugado la gobernanza en el desarrollo del modelo comunitario de salud mental en Chile. Se describen y analizan cinco dimensiones de la gobernanza: 1) el desarrollo de una serie de estrategias para favorecer la participación de los usuarios de servicios de salud mental ha logrado resultados insuficientes; 2) la implementación de tres planes nacionales de salud mental, que han mantenido la misma visión estratégica a lo largo de tres décadas, han contribuido a aumentar la accesibilidad a la atención comunitaria de las personas con enfermedades mentales y disminuir el rol de los hospitales psiquiátricos; 3) la inexistencia de una ley de salud mental persiste aún como un desafío, aunque haya sido parcialmente compensada por distintas leyes y decretos; 4) las regulaciones en la asignación de los recursos financieros, la formación del recurso humano y las directrices técnicas han contribuido a mejorar el acceso y la calidad de la atención; y 5) la construcción progresiva de un sistema de información en salud mental ha permitido conocer principalmente las tasas de acceso, las brechas de tratamiento y las inequidades geográficas. La experiencia chilena confirma la importancia de aplicar un conjunto de estrategias y mecanismos de gobernanza, para favorecer el desarrollo y el funcionamiento de los servicios de salud mental. El tipo de estrategias y mecanismos de gobernanza podrán variar en los distintos países según los contextos y las ventanas de oportunidades.
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Affiliation(s)
- Alberto Minoletti
- Unidad de Salud Mental, Instituto de Salud Poblacional (Escuela de Salud Pública Dr. Salvador Allende), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rafael Sepúlveda
- Unidad de Salud Mental, Instituto de Salud Poblacional (Escuela de Salud Pública Dr. Salvador Allende), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mauricio Gómez
- Subsecretaría de Salud Pública, Ministerio de Salud, Gobierno de Chile, Santiago, Chile
| | - Olga Toro
- Unidad de Salud Mental, Instituto de Salud Poblacional (Escuela de Salud Pública Dr. Salvador Allende), Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Matías Irarrázabal
- Departamento de Psiquiatría Norte, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Rodrigo Díaz
- Subsecretaría de Redes Asistenciales, Ministerio de Salud, Gobierno de Chile, Santiago, Chile
| | - Viviana Hernández
- Subsecretaría de Salud Pública, Ministerio de Salud, Gobierno de Chile, Santiago, Chile
| | - Susana Chacón
- Subsecretaría de Redes Asistenciales, Ministerio de Salud, Gobierno de Chile, Santiago, Chile
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17
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Lovero KL, Lammie SL, van Zyl A, Paul SN, Ngwepe P, Mootz JJ, Carlson C, Sweetland AC, Shelton RC, Wainberg ML, Medina-Marino A. Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts. BMC Health Serv Res 2019; 19:83. [PMID: 30704459 PMCID: PMC6357439 DOI: 10.1186/s12913-019-3912-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The South African National Mental Health Policy Framework and Strategic Plan 2013-2020 was adopted to address the country's substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa. METHODS Forty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services. RESULTS A total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n = 85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population. CONCLUSIONS Though some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.
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Affiliation(s)
- Kathryn L. Lovero
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY 10032 USA
| | - Samantha L. Lammie
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA 30307 USA
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
| | - André van Zyl
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
| | - Sharon N. Paul
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
| | - Phuti Ngwepe
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
| | - Jennifer J. Mootz
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA 30307 USA
| | - Catherine Carlson
- School of Social Work, University of Alabama, 3026 Little Hall, Box 870314, Tuscaloosa, AL 35487-0314 USA
| | - Annika C. Sweetland
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY 10032 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St. #941, New York, NY 10032 USA
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY 10032 USA
| | - Andrew Medina-Marino
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
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18
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Ashdown-Franks G, Stubbs B, Koyanagi A, Schuch F, Firth J, Veronese N, Vancampfort D. Handgrip strength and depression among 34,129 adults aged 50 years and older in six low- and middle-income countries. J Affect Disord 2019; 243:448-454. [PMID: 30273883 DOI: 10.1016/j.jad.2018.09.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/16/2018] [Accepted: 09/15/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Handgrip strength is a simple and inexpensive marker of health and mortality risk. It presents an ideal risk-stratifying method for use in low and middle-income countries (LMICs). There are, however, no population-based studies investigating the associations between handgrip strength and depression in LMICs. We aimed to assess these associations among community-dwelling middle-aged and older adults using nationally representative data from six LMICs. METHOD Cross-sectional data on individuals aged ≥ 50 years from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. Depression was based on the Composite International Diagnostic Interview. Weak handgrip strength was defined as < 30 kg for men and < 20 kg for women using the average value of two handgrip measurements of the dominant hand. Multivariable logistic regression analysis was conducted. RESULTS The sample included 34,129 individuals (62.4 ± 16.0 years; 52.1% female). The prevalence of weak handgrip strength and depression were 47.4% and 6.2%, respectively. Individuals with weak handgrip strength had a higher prevalence of depression than those without this condition (8.8% vs. 3.8%; p < 0.001). Across all countries, after adjustment for potential confounders, weak handgrip strength was associated with a 1.45 (95%CI = 1.12-1.88) times higher odds for depression, although some between-country differences were noted. DISCUSSION Weaker handgrip strength is associated with higher odds for depression in LMICs. Future research should seek to establish the predictive value of this inexpensive measure for clinical use. Furthermore, interventional studies should examine if muscular strength can be a target of resistance-training interventions to address depressive symptoms in low-resourced settings.
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Affiliation(s)
- Garcia Ashdown-Franks
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London,De Crespigny Park, London Box SE5 8AF, United Kingdom; Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada.
| | - Brendon Stubbs
- Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Felipe Schuch
- La Salle University, Canoas, Brazil; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Nicola Veronese
- Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Tervuursevest 101, Leuven 3001, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, Kortenberg 3070, Belgium
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19
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Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal. Glob Ment Health (Camb) 2019; 6:e15. [PMID: 31391947 PMCID: PMC6669965 DOI: 10.1017/gmh.2019.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. METHODS A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35-60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. RESULTS A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4-50.4)]. The difference in BDI scores at T2 between PSY and EUC was -7.43 (95% CI -9.71 to -5.14). CONCLUSIONS Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings.
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Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, Chisholm D, Collins PY, Cooper JL, Eaton J, Herrman H, Herzallah MM, Huang Y, Jordans MJD, Kleinman A, Medina-Mora ME, Morgan E, Niaz U, Omigbodun O, Prince M, Rahman A, Saraceno B, Sarkar BK, De Silva M, Singh I, Stein DJ, Sunkel C, UnÜtzer JÜ. The Lancet Commission on global mental health and sustainable development. Lancet 2018; 392:1553-1598. [PMID: 30314863 DOI: 10.1016/s0140-6736(18)31612-x] [Citation(s) in RCA: 1178] [Impact Index Per Article: 196.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/11/2018] [Accepted: 07/05/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Vikram Patel
- Harvard Medical School, Boston, MA, USA; Harvard TH Chan School of Public Health, Boston, MA, USA; Sangath, Goa, India; Public Health Foundation of India, New Delhi, India.
| | - Shekhar Saxena
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London UK
| | - Florence Baingana
- WHO Sierra Leone, Freetown, Sierra Leone; Makerere University School of Public Health, Kampala, Uganda
| | - Paul Bolton
- Department of International Health and Department of Mental Health, Center for Humanitarian Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dan Chisholm
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - Pamela Y Collins
- University of Washington School of Medicine and School of Public Health, Seattle, WA, USA
| | - Janice L Cooper
- The Carter Center, Monrovia, Liberia; Emory University, Atlanta, GA, USA
| | - Julian Eaton
- CBM International, Bensheim, Germany; Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Herrman
- Orygen, National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia; World Psychiatric Association, Melbourne, VIC Australia; WHO Collaborating Centre in Mental Health, Melbourne, VIC Australia
| | - Mohammad M Herzallah
- Palestinian Neuroscience Initiative, Al-Quds University, Jerusalem, Palestine; Center for Molecular and Behavioral Neuroscience, Rutgers University, Newark, NJ, USA
| | - Yueqin Huang
- National Clinical Research Centre for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Mark J D Jordans
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; Research and Development, War Child, Amsterdam, Netherlands; Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Arthur Kleinman
- Department of Anthropology, Harvard University, Cambridge, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Ellen Morgan
- Templeton World Charity Foundation, Nassau, The Bahamas
| | - Unaiza Niaz
- Psychiatric Clinic and Stress Research Centre, Karachi, Pakistan; University of Health Sciences, Lahore, Pakistan; Dow University of Health Sciences, Karachi, Pakistan
| | - Olayinka Omigbodun
- College of Medicine and Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria
| | - Martin Prince
- King's Global Health Institute, King's College London, London, UK
| | - Atif Rahman
- University of Liverpool, Liverpool, UK; Human Development Research Foundation, Islamabad, Pakistan
| | - Benedetto Saraceno
- School of Medical Sciences, University Nova of Lisbon, Lisbon, Portugal; Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Bidyut K Sarkar
- PRIDE Project, Sangath, India; Public Health Foundation of India, New Delhi, India
| | | | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Groote Schuur Hospital, Cape Town, South Africa; South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Charlene Sunkel
- South African Federation for Mental Health, Johannesburg, South Africa; Movement for Global Mental Health, Johannesburg, South Africa
| | - JÜrgen UnÜtzer
- Department of Psychiatry and Behavioral Sciences and the Advancing Integrated Mental Health Solutions Center, University of Washington, Seattle, WA, USA
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Gupta I, Roy A. Economic Studies on Non-Communicable Diseases and Injuries in India: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:303-315. [PMID: 29611047 DOI: 10.1007/s40258-018-0370-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The burden from non-communicable diseases and injuries (NCDI) in India is increasing rapidly. With low public sector investment in the health sector generally, and a high financial burden on households for treatment, it is important that economic evidence is used to set priorities in the context of NCDI. OBJECTIVE Our objective was to understand the extent to which economic analysis has been used in India to (1) analyze the impact of NCDI and (2) evaluate prevention and treatment interventions. Specifically, this analysis focused on the type of economic analysis used, disease categories, funding patterns, authorship, and author characteristics. METHODS We conducted a systematic review based on economic keywords to identify studies on NCDI in India published in English between January 2006 and November 2016. In all, 96 studies were included in the review. The analysis used descriptive statistics, including frequencies and percentages. RESULTS A majority of the studies were economic impact studies, followed by economic evaluation studies, especially cost-effectiveness analysis. In the costing/partial economic evaluation category, most were cost-description and cost-analysis studies. Under the economic impact/economic burden category, most studies investigated out-of-pocket spending. The studies were mostly on cardiovascular disease, diabetes, and neoplasms. Slightly over half of the studies were funded, with funding coming mainly from outside of India. Half of the studies were led by domestic authors. In most of the studies, the lead author was a clinician or a public health professional; however, most of the economist-led studies were by authors from outside India. CONCLUSIONS The results indicate the lack of engagement of economists generally and health economists in particular in research on NCDI in India. Demand from health policy makers for evidence-based decision making appears to be lacking, which in turn solidifies the divergence between economics and health policy, and highlights the need to prioritize scarce resources based on evidence regarding what works. Capacity building in health economics needs focus, and the government's support in this is recommended.
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Affiliation(s)
- Indrani Gupta
- Institute of Economic Growth, University of Delhi Enclave, Delhi, 110007, India.
| | - Arjun Roy
- Institute of Economic Growth, University of Delhi Enclave, Delhi, 110007, India
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Keynejad RC, Dua T, Barbui C, Thornicroft G. WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries. EVIDENCE-BASED MENTAL HEALTH 2018; 21:30-34. [PMID: 28903977 PMCID: PMC10283403 DOI: 10.1136/eb-2017-102750] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 01/23/2023]
Abstract
QUESTION Despite mental, neurological and substance use (MNS) disorders being highly prevalent, there is a worldwide gap between service need and provision. WHO launched its Mental Health Gap Action Programme (mhGAP) in 2008, and the Intervention Guide (mhGAP-IG) in 2010. mhGAP-IG provides evidence-based guidance and tools for assessment and integrated management of priority MNS disorders in low and middle-income countries (LMICs), using clinical decision-making protocols. It targets a non-specialised primary healthcare audience, but has also been used by ministries, non-governmental organisations and academics, for mental health service scale-up in 90 countries. This review aimed to identify evidence to date for mhGAP-IG implementation in LMICs. STUDY SELECTION AND ANALYSIS We searched MEDLINE, Embase, PsycINFO, Web of Knowledge/Web of Science, Scopus, CINAHL, LILACS, SciELO/Web of Science, Cochrane, Pubmed databases and Google Scholar for studies reporting evidence, experience or evaluation of mhGAP-IG in LMICs, in any language. Data were extracted from included papers, but heterogeneity prevented meta-analysis. FINDINGS We conducted a systematic review of evidence to date, of mhGAP-IG implementation and evaluation in LMICs. Thirty-three included studies reported 15 training courses, 9 clinical implementations, 3 country contextualisations, 3 economic models, 2 uses as control interventions and 1 use to develop a rating scale. Our review identified the importance of detailed reports of contextual challenges in the field, alongside detailed protocols, qualitative studies and randomised controlled trials. CONCLUSIONS The mhGAP-IG literature is substantial, relative to other published evaluations of clinical practice guidelines: an important contribution to a neglected field.
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Affiliation(s)
- Roxanne C Keynejad
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Cochrane Global Mental Health and WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
We aimed to determine the prevalence and determinants of depression using mobile based mental health Global Action Programme Intervention guide (mhGAP-IG) in remote health care settings where most priority mental health problems are managed by non-mental health specialists and evaluate the feasibility of the application. Adult patients were recruited from four rural public health facilities in Kenya using systematic random sampling and screened for depression. There were no missing items since the application prevented saving of data unless all the items were answered. The prevalence of depression was 25% with suicidal behavior being the most significant comorbid problem. Older age, personal and a family history of a mental disorder were significantly correlated with depression. Exploring the use of health-related mobile applications in identification of priority mental health problems is useful notably in low-resource settings; and also forms a basis for prevention of mental disorders and intervention at acute stages.
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Petersen I, Marais D, Abdulmalik J, Ahuja S, Alem A, Chisholm D, Egbe C, Gureje O, Hanlon C, Lund C, Shidhaye R, Jordans M, Kigozi F, Mugisha J, Upadhaya N, Thornicroft G. Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies. Health Policy Plan 2017; 32:699-709. [PMID: 28369396 PMCID: PMC5406762 DOI: 10.1093/heapol/czx014] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 01/08/2023] Open
Abstract
Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries.
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Affiliation(s)
- Inge Petersen
- School of Nursing and Public Health and School of Applied Human Sciences, University of Kwazulu-Natal, Howard College, Mazisi Kunene Road, Glenwood, Durban 4001, South Africa
| | - Debbie Marais
- Undergraduate Research Office, Research Development and Support Division, Faculty of Medicine & Health Sciences, University of Stellenbosch, P.O. Box 241, Cape Town 8000, South Africa
| | - Jibril Abdulmalik
- Department of Psychiatry, University of Ibadan, Queen Elizabeth Road, Ibadan 1205, Nigeria
| | - Shalini Ahuja
- Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon, Delhi 122002, India
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Tikur Anbessa Hospital, Addis Ababa, P.O. 9086, Ethiopia
| | - Dan Chisholm
- Department of Mental Health and Substance Abuse, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Catherine Egbe
- School of Nursing and Public Health and School of Applied Human Sciences, University of Kwazulu-Natal, Howard College, Mazisi Kunene Road, Glenwood, Durban 4001, South Africa
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Queen Elizabeth Road, Ibadan 1205, Nigeria
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Tikur Anbessa Hospital, Addis Ababa, P.O. 9086, Ethiopia.,Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Crick Lund
- Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town 7700, South Africa
| | - Rahul Shidhaye
- Public Health Foundation of India, Plot Number 47, Sector 44, Gurgaon, Delhi 122002, India
| | - Mark Jordans
- Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Department of Research and Development, HealthNet TPO, Lizzy Ansinghstraat 163, Amsterdam, RG 1073, Netherlands
| | - Fred Kigozi
- Butabika National Referral and Teaching, Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - James Mugisha
- Butabika National Referral and Teaching, Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Nawaraj Upadhaya
- Transcultural Psychosocial Organization (TPO), Kathmandu, CPC 612, Nepal
| | - Graham Thornicroft
- Institute of Psychiatry, Psychology and Neuroscience, Center for Global Mental Health, King's College London, De Crespigny Park, London, SE5 8AF, UK
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Eckardt P, Culley JM, Corwin E, Richmond T, Dougherty C, Pickler RH, Krause-Parello CA, Roye CF, Rainbow JG, DeVon HA. National nursing science priorities: Creating a shared vision. Nurs Outlook 2017; 65:726-736. [PMID: 28711216 DOI: 10.1016/j.outlook.2017.06.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/29/2017] [Accepted: 06/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Nursing science is essential to advance population health through contributions at all phases of scientific inquiry. Multiple scientific initiatives important to nursing science overlap in aims and population focus. PURPOSE This article focused on providing the American Academy of Nursing and nurse scientists in the Unites States with a blueprint of nursing science priorities to inform a shared vision for future collaborations, areas of scientific inquiry, and resource allocation. METHODS The Science Committee convened four times and using Delphi methods identified priorities with empirical evidence and expert opinion for prioritization, state of the science, expert interest, and potential target stakeholders. DISCUSSION Nursing science priorities for 2017 were categorized into four themes including: (a) precision science, (b) big data and data analytics, (c) determinants of health, and (d) global health. CONCLUSION Nurse scientists can generate new knowledge in priority areas that advances the health of the world's populations.
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Affiliation(s)
- Patricia Eckardt
- Molloy College Barbara H. Hagan School of Nursing, Rockville Centre, NY.
| | - Joan M Culley
- University of South Carolina College of Nursing, Columbia, SC
| | - Elizabeth Corwin
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | | | | | - Rita H Pickler
- The Ohio State University College of Nursing, Columbus, OH
| | | | - Carol F Roye
- Pace University College of Health Professions, Pleasantville, NY
| | | | - Holli A DeVon
- University of Illinois at Chicago College of Nursing, Chicago, IL
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Scaling-up services for psychosis, depression and epilepsy in sub-Saharan Africa and South Asia: development and application of a mental health systems planning tool (OneHealth). Epidemiol Psychiatr Sci 2017; 26:234-244. [PMID: 27641074 PMCID: PMC7032803 DOI: 10.1017/s2045796016000408] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Although financing represents a critical component of health system strengthening and also a defining concern of efforts to move towards universal health coverage, many countries lack the tools and capacity to plan effectively for service scale-up. As part of a multi-country collaborative study (the Emerald project), we set out to develop, test and apply a fully integrated health systems resource planning and health impact tool for mental, neurological and substance use (MNS) disorders. METHODS A new module of the existing UN strategic planning OneHealth Tool was developed, which identifies health system resources required to scale-up a range of specified interventions for MNS disorders and also projects expected health gains at the population level. We conducted local capacity-building in its use, as well as stakeholder consultations, then tested and calibrated all model parameters, and applied the tool to three priority mental and neurological disorders (psychosis, depression and epilepsy) in six low- and middle-income countries. RESULTS Resource needs for scaling-up mental health services to reach desired coverage goals are substantial compared with the current allocation of resources in the six represented countries but are not large in absolute terms. In four of the Emerald study countries (Ethiopia, India, Nepal and Uganda), the cost of delivering key interventions for psychosis, depression and epilepsy at existing treatment coverage is estimated at US$ 0.06-0.33 per capita of total population per year (in Nigeria and South Africa it is US$ 1.36-1.92). By comparison, the projected cost per capita at target levels of coverage approaches US$ 5 per capita in Nigeria and South Africa, and ranges from US$ 0.14-1.27 in the other four countries. Implementation of such a package of care at target levels of coverage is expected to yield between 291 and 947 healthy life years per one million populations, which represents a substantial health gain for the currently neglected and underserved sub-populations suffering from psychosis, depression and epilepsy. CONCLUSIONS This newly developed and validated module of OneHealth tool can be used, especially within the context of integrated health planning at the national level, to generate contextualised estimates of the resource needs, costs and health impacts of scaled-up mental health service delivery.
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Wainberg ML, Scorza P, Shultz JM, Helpman L, Mootz JJ, Johnson KA, Neria Y, Bradford JME, Oquendo MA, Arbuckle MR. Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. Curr Psychiatry Rep 2017; 19:28. [PMID: 28425023 PMCID: PMC5553319 DOI: 10.1007/s11920-017-0780-z] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. RECENT FINDINGS Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.
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Affiliation(s)
- Milton L Wainberg
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA.
| | - Pamela Scorza
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - James M Shultz
- Center for Disaster and Extreme Event Preparedness (DEEP Center), University of Miami Miller School of Medicine, Miami, FL, 33160, USA
| | - Liat Helpman
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Jennifer J Mootz
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Karen A Johnson
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Yuval Neria
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Jean-Marie E Bradford
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 200, Philadelphia, PA, 19104-3309, USA
| | - Melissa R Arbuckle
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY, 10032, USA
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Watila MM, Keezer MR, Angwafor SA, Winkler AS, Sander JW. Health service provision for people with epilepsy in sub-Saharan Africa: A situational review. Epilepsy Behav 2017; 70:24-32. [PMID: 28410462 DOI: 10.1016/j.yebeh.2017.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Epilepsy is a public health issue in sub-Saharan Africa (SSA) where many people with the condition receive no treatment. Health-care services for epilepsy in this region have not been comprehensively assessed. We examined key features of epilepsy health services provided in SSA. METHODOLOGY This was a scoping review conducted using pre-specified protocols. We implemented an electronic search strategy to identify relevant citations using PUBMED, EMBASE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Index Medicus (AIM), Open Grey, Cochrane database, and Google Scholar. Articles eligible for full-text review were screened and data of interest were reported. RESULT The search identified 81 eligible articles, forty-nine from East Africa, 19 from West Africa, 8 from South Africa, and 5 from Central Africa. A variety of care services were identified, with reporting of rural epilepsy care in 75% of retrieved articles mainly from East and South African countries. The majority of the rural epilepsy clinics were health worker- or nurse-led, reporting good seizure control in about two-thirds of patients using phenobarbital as the most commonly prescribed antiepileptic drug. Funding for rural epilepsy care came mainly from external donor agencies. CONCLUSION We attempted to provide a 'snapshot' of epilepsy care services in SSA. The successes achieved in some of the centers are due to the use of existing primary health-care systems and employing non-physician health-care personnel. The true picture of epilepsy care coverage is not apparent due to the lack of data and proper health system structure in most parts of SSA. As more individuals begin to receive care, the long-term funding for epilepsy care in African countries will depend on the commitment of their respective governments.
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Affiliation(s)
- Musa M Watila
- Neurology Unit, Department of Medicine, University of Maiduguri Teaching Hospital, PMB 1414, Maiduguri, Borno State, Nigeria; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK
| | - Mark R Keezer
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK; Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, Montréal, Québec H2L 4M1, Canada; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands
| | - Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK
| | - Andrea S Winkler
- Centre for Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Department of Neurology, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, 2103 SW Heemstede, Netherlands.
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Raykar N, Nigam A, Chisholm D. An extended cost-effectiveness analysis of schizophrenia treatment in India under universal public finance. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2016; 14:9. [PMID: 27398070 PMCID: PMC4938947 DOI: 10.1186/s12962-016-0058-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households. AIMS AND METHODS This paper reports on an 'extended' cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles. RESULTS Using plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income. CONCLUSIONS Universal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.
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Affiliation(s)
- Neha Raykar
- />Public Health Foundation of India, Plot No 47, Sector 44, Gurgaon, Haryana 122002 India
| | - Aditi Nigam
- />Center for Disease Dynamics, Economics and Policy, 1400 Eye St NW, Suite 500, Washington, DC 20005 USA
| | - Dan Chisholm
- />Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, Saxena S. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry 2016; 3:415-24. [PMID: 27083119 DOI: 10.1016/s2215-0366(16)30024-4] [Citation(s) in RCA: 704] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/15/2016] [Accepted: 03/17/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. Here we propose a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders. METHODS In this global return on investment analysis, we used the mental health module of the OneHealth tool to calculate treatment costs and health outcomes in 36 countries between 2016 and 2030. We assumed a linear increase in treatment coverage. We factored in a modest improvement of 5% in both the ability to work and productivity at work as a result of treatment, subsequently mapped to the prevailing rates of labour participation and gross domestic product (GDP) per worker in each country. FINDINGS The net present value of investment needed over the period 2016-30 to substantially scale up effective treatment coverage for depression and anxiety disorders is estimated to be US$147 billion. The expected returns to this investment are also substantial. In terms of health impact, scaled-up treatment leads to 43 million extra years of healthy life over the scale-up period. Placing an economic value on these healthy life-years produces a net present value of $310 billion. As well as these intrinsic benefits associated with improved health, scaled-up treatment of common mental disorders also leads to large economic productivity gains (a net present value of $230 billion for scaled-up depression treatment and $169 billion for anxiety disorders). Across country income groups, resulting benefit to cost ratios amount to 2·3-3·0 to 1 when economic benefits only are considered, and 3·3-5·7 to 1 when the value of health returns is also included. INTERPRETATION Return on investment analysis of the kind reported here can contribute strongly to a balanced investment case for enhanced action to address the large and growing burden of common mental disorders worldwide. FUNDING Grand Challenges Canada.
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Affiliation(s)
- Dan Chisholm
- Department of Mental Health and Substance Abuse, WHO, Geneva, Switzerland.
| | - Kim Sweeny
- Victoria Institute of Strategic Economic Studies, Melbourne, VIC, Australia
| | - Peter Sheehan
- Victoria Institute of Strategic Economic Studies, Melbourne, VIC, Australia
| | - Bruce Rasmussen
- Victoria Institute of Strategic Economic Studies, Melbourne, VIC, Australia
| | - Filip Smit
- Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands; Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Netherlands
| | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, WHO, Geneva, Switzerland
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Applications of the epidemiological modelling outputs for targeted mental health planning in conflict-affected populations: the Syria case-study. Glob Ment Health (Camb) 2016; 3:e8. [PMID: 28596877 PMCID: PMC5314753 DOI: 10.1017/gmh.2016.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/03/2015] [Accepted: 01/20/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Epidemiological models are frequently utilised to ascertain disease prevalence in a population; however, these estimates can have wider practical applications for informing targeted scale-up and optimisation of mental health services. We explore potential applications for a conflict-affected population, Syria. METHODS We use prevalence estimates of major depression and post-traumatic stress disorder (PTSD) in conflict-affected populations as inputs for subsequent estimations. We use Global Burden of Disease (GBD) methodology to estimate years lived with a disability (YLDs) for depression and PTSD in Syrian populations. Human resource (HR) requirements to scale-up recommended packages of care for PTSD and depression in Syria over a 15-year period were modelled using the World Health Organisation mhGAP costing tool. Associated avertable burden was estimated using health benefit analyses. RESULTS The total number of cases of PTSD in Syria was estimated at approximately 2.2 million, and approximately 1.1 million for depression. An age-standardised major depression rate of 13.4 (95% UI 9.8-17.5) YLDs per 1000 Syrian population is estimated compared with the GBD 2010 global age-standardised YLD rate of 9.2 (95% UI 7.0-11.8). HR requirements to support a linear scale-up of services in Syria using the mhGAP costing tool demonstrates a steady increase from 0.3 FTE in at baseline to 7.6 FTE per 100 000 population after scale-up. Linear scale-up over 15 years could see 7-9% of disease burden being averted. CONCLUSION Epidemiological estimates of mental disorders are key inputs into determining disease burden and guiding optimal mental health service delivery and can be used in target populations such as conflict-affected populations.
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Lund C, Tomlinson M, Patel V. Integration of mental health into primary care in low- and middle-income countries: the PRIME mental healthcare plans. Br J Psychiatry 2016; 208 Suppl 56:s1-3. [PMID: 26447177 PMCID: PMC4698550 DOI: 10.1192/bjp.bp.114.153668] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Indexed: 11/23/2022]
Abstract
This supplement outlines the development and piloting of district mental healthcare plans from five low- and middle-income countries, together with the methods for their design, evaluation and costing. In this editorial we consider the challenges that these programmes face, highlight their innovations and draw conclusions.
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Affiliation(s)
- Crick Lund
- Crick Lund, BA, BSocSci (Hons), MA, MSoSci (ClinPsych), PhD, 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; Mark Tomlinson, BA, BA (Hons), MA (ClinPsych), PhD, Alan J Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University and Department of Psychiatry and Mental Health, University of Cape Town, Stellenbosch, South Africa; Vikram Patel, PhD, MRCPsych, FMedSci, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, Centre for Chronic Conditions and Injuries, the Public Health Foundation of India, New Delhi, and Sangath Centre, Goa, India
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Jordans MJD, Luitel NP, Pokhrel P, Patel V. Development and pilot testing of a mental healthcare plan in Nepal. Br J Psychiatry 2016; 208 Suppl 56:s21-8. [PMID: 26447173 PMCID: PMC4698553 DOI: 10.1192/bjp.bp.114.153718] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 01/12/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mental health service delivery models that are grounded in the local context are needed to address the substantial treatment gap in low- and middle-income countries. AIMS To present the development, and content, of a mental healthcare plan (MHCP) in Nepal and assess initial feasibility. METHOD A mixed methods formative study was conducted. Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from patients (n = 135) during the pilot-testing phase in two health facilities. RESULTS The resulting MHCP consists of 12 packages, divided over community, health facility and organisation platforms. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers and high drop-out rates. CONCLUSIONS The MHCP follows a collaborative care model encompassing community and primary healthcare interventions.
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Affiliation(s)
- M. J. D. Jordans
- Correspondence: Mark Jordans, Research & Development, HealthNet TPO, Lizzy Ansinghstraat 163, 1072 RG, Amsterdam, The Netherlands.
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Hanlon C, Fekadu A, Jordans M, Kigozi F, Petersen I, Shidhaye R, Honikman S, Lund C, Prince M, Raja S, Thornicroft G, Tomlinson M, Patel V. District mental healthcare plans for five low- and middle-income countries: commonalities, variations and evidence gaps. Br J Psychiatry 2016; 208 Suppl 56:s47-54. [PMID: 26447169 PMCID: PMC4698556 DOI: 10.1192/bjp.bp.114.153767] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/19/2014] [Indexed: 12/04/2022]
Abstract
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.
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Affiliation(s)
- Charlotte Hanlon
- Correspondence: Charlotte Hanlon, Department of Psychiatry, 6th Floor College of Health Sciences Building, Tikur Anbessa Hospital, Addis Ababa, PO 9086, Ethiopia.
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Kigozi FN, Kizza D, Nakku J, Ssebunnya J, Ndyanabangi S, Nakiganda B, Lund C, Patel V. Development of a district mental healthcare plan in Uganda. Br J Psychiatry 2016; 208 Suppl 56:s40-6. [PMID: 26447171 PMCID: PMC4698555 DOI: 10.1192/bjp.bp.114.153742] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence is needed for the integration of mental health into primary care advocated by the national health sector strategic investment plan in Uganda. AIMS To describe the processes of developing a district mental healthcare plan (MHCP) in rural Uganda that facilitates integration of mental health into primary care. METHOD Mixed methods using a situational analysis, qualitative studies, theory of change workshops and partial piloting of the plan at two levels informed the MHCP. RESULTS A MHCP was developed with packages of care to facilitate integration at the organisational, facility and community levels of the district health system, including a specified human resource mix. The partial embedding period supports its practical application. Key barriers to scaling up the plan were identified. CONCLUSIONS A real-world plan for the district was developed with involvement of stakeholders. Pilot testing demonstrated its feasibility and implications for future scaling up.
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Affiliation(s)
- Fred N. Kigozi
- Correspondence: Fred Kigozi, Butabika National Referral and Teaching Mental Hospital, Makerere University, Kampala, Uganda.
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Petersen I, Fairall L, Bhana A, Kathree T, Selohilwe O, Brooke-Sumner C, Faris G, Breuer E, Sibanyoni N, Lund C, Patel V. Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. Br J Psychiatry 2016; 208 Suppl 56:s29-39. [PMID: 26447176 PMCID: PMC4698554 DOI: 10.1192/bjp.bp.114.153726] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND In South Africa, the escalating prevalence of chronic illness and its high comorbidity with mental disorders bring to the fore the need for integrating mental health into chronic care at district level. AIMS To develop a district mental healthcare plan (MHCP) in South Africa that integrates mental healthcare for depression, alcohol use disorders and schizophrenia into chronic care. METHOD Mixed methods using a situation analysis, qualitative key informant interviews, theory of change workshops and piloting of the plan in one health facility informed the development of the MHCP. RESULTS Collaborative care packages for the three conditions were developed to enable integration at the organisational, facility and community levels, supported by a human resource mix and implementation tools. Potential barriers to the feasibility of implementation at scale were identified. CONCLUSIONS The plan leverages resources and systems availed by the emerging chronic care service delivery platform for the integration of mental health. This strengthens the potential for future scale up.
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Affiliation(s)
- Inge Petersen
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Lara Fairall
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Arvin Bhana
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Tasneem Kathree
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - One Selohilwe
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Carrie Brooke-Sumner
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Gill Faris
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Erica Breuer
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Nomvula Sibanyoni
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Crick Lund
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
| | - Vikram Patel
- Inge Petersen, PhD, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Lara Fairall, PhD, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Arvin Bhana, PhD, Tasneem Kathree, MSocSci, One Selohilwe, MSocSci, Carrie Brooke-Sumner, MSc, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa; Gill Faris, MPhil, Knowledge Translation Unit, University of Cape Town, Cape Town, South Africa; Erica Breuer, MPH, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Nomvula Sibanyoni, MSocSci, National Department of Health, Pretoria, South Africa; Crick Lund, PhD, 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; Vikram Patel, PhD, Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK and Centre for Mental Health, the Public Health Foundation of India, India
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Shidhaye R, Lund C, Chisholm D. Closing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions. Int J Ment Health Syst 2015; 9:40. [PMID: 26719762 PMCID: PMC4696279 DOI: 10.1186/s13033-015-0031-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 12/18/2015] [Indexed: 10/30/2022] Open
Abstract
This paper outlines the main elements and features of a mental health care delivery platform and its delivery channels. These include evidence-based interventions that can be delivered via this platform as well as broader health system strengthening strategies for more effective and efficient delivery of services. The focus is broadly on health systems perspective rather than strictly disorder-oriented intervention analysis. A set of evidence-based interventions within the WHO pyramid framework of self-care, primary care, and specialist care have been identified; the main challenge lies in the translation of that evidence into practice. The delivery of these interventions requires an approach that puts into practice key principles of public health, adopts systems thinking, promotes whole-of-government involvement and is focused on quality improvement. Key strategies for effective translation of evidence into action include collaborative stepped care, strengthening human resources, and integrating mental health into general health care. In order to pursue these principles and strategies using a platform-wide approach, policy makers need to engage with a wide range of stakeholders and make use of the best available evidence in a transparent manner.
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Affiliation(s)
- Rahul Shidhaye
- />Centre for Chronic Conditions and Injuries, Public Health Foundation of India, 19, Rishi Nagar, Char Imli, Bhopal, Madhya Pradesh India
- />CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Crick Lund
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
- />Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Dan Chisholm
- />Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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