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Thapa P, Marahatta K, Upadhyay Raj S, Sapkota N, Baral P, Lama S, Kamholz B, Paudel S, Basnet M. Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan. Int J Geriatr Psychiatry 2024; 39:e6111. [PMID: 38862409 DOI: 10.1002/gps.6111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/23/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan. METHODOLOGY This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023). RESULTS Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place. CONCLUSIONS This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.
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Affiliation(s)
- P Thapa
- Department of Psychiatric Nursing, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- Global Brain Health Institute, Trinity College, Dublin, Ireland
| | - K Marahatta
- Mental Health Unit, WHO Country Office, Kathmandu, Nepal
| | | | - N Sapkota
- Patan Academy of Health Sciences, Lalitpur, Nepal
| | - P Baral
- Epidemiology and Disease Control Division, Department of Health Services, Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | - S Lama
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - B Kamholz
- University of California San Francisco, San Francisco, California, USA
| | - S Paudel
- Nursing and Social Security Division, Department of Health Services, Government of Nepal Ministry of Health and Population, Kathmandu, Nepal
| | - M Basnet
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Almanzar S. Advancing Global Health Through Primary Care Physician Education on Suicide Prevention. Ann Glob Health 2024; 90:32. [PMID: 38800707 PMCID: PMC11122702 DOI: 10.5334/aogh.4410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
The rising global suicide rate presents a major public health concern, resulting in the loss of over 700,000 lives annually. Discrepancies in the impact of suicide among diverse populations underscore the necessity for targeted prevention strategies. Primary care providers (PCPs) play a crucial role in identifying and managing suicide risk, particularly in underserved areas with limited access to mental health care. Educating PCPs about evidence-based interventions and suicide prevention strategies has demonstrated effectiveness in reducing suicide rates. Landmark initiatives in Australia, Sweden, and Hungary have successfully lowered suicide rates by implementing educational programs for PCPs focused on suicide prevention. Denmark, previously afflicted by some of the highest rates globally in the 1980s, has significantly reduced its figures and now ranks among countries with the lowest rates in high-income nations. Collaborative programs involving PCPs and health workers in low-resource regions have also shown promising outcomes in suicide prevention efforts. Enhancing the expertise of PCPs in suicide prevention can fortify healthcare systems, prioritize mental health, and ultimately save lives, contributing to global health endeavors aimed at addressing the pervasive issue of suicide.
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McGinty EE, Alegria M, Beidas RS, Braithwaite J, Kola L, Leslie DL, Moise N, Mueller B, Pincus HA, Shidhaye R, Simon K, Singer SJ, Stuart EA, Eisenberg MD. The Lancet Psychiatry Commission: transforming mental health implementation research. Lancet Psychiatry 2024; 11:368-396. [PMID: 38552663 DOI: 10.1016/s2215-0366(24)00040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
| | - Margarita Alegria
- Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lola Kola
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Kings College London, London, UK
| | | | | | | | | | - Rahul Shidhaye
- Pravara Institute of Medical Sciences University, Loni, India; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sara J Singer
- Stanford University School of Medicine, Stanford, CA, USA
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Graham Bn Advanced Prac Cmhn N, Whitaker BSocWk Msw PhD L, Smith BSocSci Hons St Class PhD Oam G, Hurley Cmhn PhD J. Trauma-Informed Care in Acute Adult Public Mental Health Settings: A Scoping Study Examining Implementation. Issues Ment Health Nurs 2024; 45:217-231. [PMID: 38466388 DOI: 10.1080/01612840.2024.2308543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Trauma-informed care (TIC) is not a new concept. Despite TIC being at the forefront of international acute public mental health services policy, and researched since 2006, implementation has been hampered. This paper reports findings from a scoping study examining clinical and lived experience workers experience of TIC in Acute Adult Public Mental Health Services. In this scoping study five databases and grey literature were scanned in 2021 and updated in 2023, to address the question: What is known about TIC concerning the clinical and mental health lived experience workforce in the acute adult public mental health service? Forty-six papers met the inclusion criteria. Analysis revealed commitment in conceptualisation of TIC in mental health policy, requirements for incorporating TIC in acute adult mental health care, and barriers to implementation, including dissonance towards role expectations. The literature calls for investment in implementing TIC, which includes an increased workforce consisting of mental health lived experience workers, clinical staff with TIC knowledge and skills, and specialist TIC experts. Further research is needed to understand more fully the opportunities and barriers to implementing TIC in acute public mental health settings.
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Mwangi G, Sakyi L, Ae-Ngibise KA, Lund C, Weobong B. Mental health and disability research in Ghana: a rapid review. Pan Afr Med J 2023; 45:166. [PMID: 37900204 PMCID: PMC10611911 DOI: 10.11604/pamj.2023.45.166.38808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/02/2023] [Indexed: 10/31/2023] Open
Abstract
The objective of this rapid review was to explore the current evidence base for mental health and disability research in Ghana. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist was followed. Online databases were used to identify primary studies, systematic reviews, meta-analyses, rapid reviews, or guidelines published between 2010 and 2020. All relevant published (both peer-reviewed articles and grey literature) on mental health and/or disability research conducted in or on Ghana between 2010 and 2020 were included in this review. 4,791 articles were identified in the initial search. After the removal of duplicates, followed by title and abstract screening, 930 articles were selected for full-text review. An additional 8 articles identified from reference lists of included articles were also included in full-text review. After review, 375 articles were selected for inclusion; 234 (62%) were on mental health while the remaining 141 (38%) were on disability. There is an increasing trend in the absolute number of mental health and/or disability studies. Most of the mental health studies included in this review were either observational quantitative studies (n=132; 56%) or observational qualitative studies (n=79; 34%). There were very few interventional studies (n=6; 3%). A similar finding was noted for the disability studies. External funding accounted for 51% of mental health articles. Although there was a steady year-on-year increase in the absolute number of mental health and/or disability studies conducted between 2010 to 2020, there is a need for more intervention studies to evaluate what mental health and/or disability interventions work, for whom, and under what circumstances. These should include evaluations of the cost, benefits, effectiveness, and acceptability of various interventions for policy and planning. Further, there is a need for the Ministry of Health to prioritize research funding for mental health and disability and enhance technical and methodological capacity of researchers to conduct disability and mental health research in Ghana.
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Affiliation(s)
| | - Lionel Sakyi
- Ghana Somubi Dwumadie (Ghana Participation Programme), East Legon, Accra, Ghana
| | - Kenneth Ayuurebobi Ae-Ngibise
- Ghana Somubi Dwumadie (Ghana Participation Programme), East Legon, Accra, Ghana
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's Global Health Institute, King's College London, London, United Kingdom
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Benedict Weobong
- Department of Social and Behavioural Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
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Akena D, Kiguba R, Muwhezi WW, Kwesiga B, Kigozi G, Lukwata H, Nakasujja N. The prevalence and factors associated with mental disorders in a community setting in central Uganda. PLoS One 2023; 18:e0285091. [PMID: 37141327 PMCID: PMC10159349 DOI: 10.1371/journal.pone.0285091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 04/15/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Mental disorders are known to predict poverty, morbidity and mortality. In resource limited settings, low levels of mental health literacy (MHL) and high mental illness stigma (MIS) have been sighted as possible factors that may impede access to mental health care. However, little has been done to examine the association between mental disorders and these factors (MHL and MIS) in sub-Saharan Africa. METHODS We assessed for the prevalence of major depressive disorders (MDD), substance use disorders (SUD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), documented MHL and MIS among 814 participants from 24 villages in central Uganda. We conducted regression analyses to examine the association between the prevalence of mental disorders, demographic factors as well as MIS and MHL. RESULTS Over two thirds of the participants 581 (70%) were female. The mean age of the participants was 38 years (SD± 13.5). The prevalence of mental disorders ranged from 6.8-32%. Participants who were older were less likely to screen positive for GAD (OR 0.98; 0.96-0.99), female gender was protective against SUD (OR 0.46; 0.3-0.68) and those with MDD had lower education level (OR 0.23; 0.1-0.53). The mean MIS score was 11.3 (SD± 5.4) with a range of 6-30 and the mean MHL score was 21.7 (SD ±3.0) with a range of 10-30. MIS was negatively associated with GAD [β = -1.211 (-2.382 to -0.040)]. There no statistically significant association between MHL and a mental disorder. CONCLUSION There was a high prevalence of mental disorders in the community that we studied. Adequate resources should be allocated to address this burden.
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Affiliation(s)
- Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Kiguba
- Department of Pharmacology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Wilson W. Muwhezi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Brendan Kwesiga
- Health Systems Strengthening Cluster, World Health Organization, Kenya Country Office, Gigiri, Kenya
| | - Gwendolyne Kigozi
- Grants office, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hafsa Lukwata
- Department of Mental Health, Ministry of Health of Uganda, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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Siddaiah A, Srinivasan K, Satyanarayana V, Ekstrand ML. Feasibility and preliminary efficacy of training health workers in detecting Priority Mental Health Conditions among adolescents in rural South India. Pilot Feasibility Stud 2022; 8:267. [PMID: 36587228 PMCID: PMC9805108 DOI: 10.1186/s40814-022-01215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/29/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Half of all mental disorders start during adolescence, before 14 years. In India, the current prevalence of mental disorders in 13-17 years age group was 7.3%. Many gaps persist in the mental healthcare delivery through the national mental health program, the low psychiatrist population ratio being one of them. Community health workers can play an essential role in providing mental healthcare in such resource-constrained settings. The World Health Organization mental health gap action program (WHO mhGAP) is a widely studied mental health tool that health workers can use to identify mental disorders. The study's aim was to test the preliminary efficacy of training healthcare workers (HCWs) in identifying mental health conditions among adolescents using modified WHO mhGAP modules. METHODS The feasibility study was carried out in two Primary Health Centers (PHCs) in rural Bengaluru. Study had two components: (1) training of HCWs on adolescent mental health and (2) detection of selected priority mental health conditions among adolescents by trained HCWs. HCWs were trained in five adolescent mental health conditions using a training manual and modified WHO mhGAP modules that excluded emergency presentations and management sections. Pre- and post-training assessments were carried out. A sample of 272 adolescents attending PHCs were assessed for any mental health condition by HCWs using mhGAP modules. A sub-sample of adolescents and all adolescents identified by HCWs with a mental health condition was interviewed by the investigator to validate the diagnosis. Qualitative interviews were carried out with participating HCWs to understand the acceptability of the intervention, acceptability, and barriers to training in identifying mental health conditions among adolescents RESULTS: A total of 23 HCWs underwent training. There was a significant increase in the mental health knowledge scores of HCWs post-training compared to baseline (p value <0.001). Out of 272 adolescents, 18 (6.8%) were detected to have any mental health condition by HCWs as per the modified WHO mhGAP modules. A sample of 72 adolescents consisting of all adolescents identified with a mental health condition by HCWs and a random sample of adolescents without any diagnosis were validated by the research investigator (AS). There was a good agreement between diagnosis by health workers and the research investigator with a Cohen's Kappa of 0.88. Four themes emerged from the qualitative analysis. CONCLUSIONS Training was effective in improving the knowledge of HCWs. There was a good agreement between trained HCWs and the investigator in detecting adolescent mental health conditions using modified mhGAP modules. The modified WHO mhGAP can thus be used by trained non-specialist HCWs to screen for adolescent mental health conditions in primary health centers.
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Affiliation(s)
- Archana Siddaiah
- grid.416432.60000 0004 1770 8558Community Health Department, St John’s Medical College Hospital, Sarjapur road, John Nagar, Kormangala, Bengaluru, 560034 India
| | - Krishnamachari Srinivasan
- grid.416432.60000 0004 1770 8558Department of Psychiatry, St John’s Medical College, Head, Division of Mental Health and Neurosciences, St John’s Research Institute, Bengaluru, 560034 India
| | - Veena Satyanarayana
- grid.416861.c0000 0001 1516 2246Department of Clinical Psychology, National Institute of Mental Health and Neuro Science, Bengaluru, 560034 India
| | - Maria L. Ekstrand
- grid.266102.10000 0001 2297 6811Department of Medicine, Division of Prevention Science, University of California, San Francisco, USA
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Keynejad RC, Spagnolo J, Thornicroft G. Mental healthcare in primary and community-based settings: evidence beyond the WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide. EVIDENCE-BASED MENTAL HEALTH 2022; 25:e1-e7. [PMID: 35473750 PMCID: PMC9811100 DOI: 10.1136/ebmental-2021-300401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/04/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The WHO's Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) has been widely used in low and middle-income countries. We reviewed literature describing interventions and training programmes beyond the mhGAP-IG, in primary healthcare (PHC) and community-based healthcare (CBH). DESIGN We searched studies excluded from our updated mhGAP-IG systematic review, and included in other relevant systematic reviews, for evidence and experience of initiatives integrating mental health into PHC and CBH. Our 24 November 2020 mhGAP-IG search encompassed MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie and Google Scholar. Although heterogeneity prevented meta-analysis, we descriptively summarised the evidence-base. RESULTS Out of 1827 results, we identified 208 relevant records. They described randomised controlled trials of mental health interventions (98 studies, n=55 523 participants), non-randomised studies measuring clinical outcomes (22 studies, n=7405), training outcomes (36 studies, n=12 280) and implementation outcomes (21 studies, n=1090), plus descriptive accounts (18 studies, n=2526), baseline surveys and exploratory studies (6 studies, n=17 093) and commentaries (7 studies). Most (40%) were conducted in the African region, region of the Americas (16%), and South-East Asia (13%). Randomised and non-randomised studies reported improved symptoms, substance use, functioning, parenting and child outcomes. Non-randomised studies reported improved clinical knowledge, confidence and skills following training. CONCLUSIONS The literature beyond the mhGAP-IG is extensive and shares common findings. Future priorities are less-studied regions, interventions for severe mental illness, exploring ways that mhGAP-IG and alternative approaches complement each other in different contexts and scaling-up mental health integration.PROSPERO registration numberCRD42017068459.
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Affiliation(s)
- Roxanne C Keynejad
- Health Service and Population Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche Charles-Le Moyne, Campus de Longueuil, Université de Sherbrooke, Sherbrooke, Canada
| | - Graham Thornicroft
- Health Service and Population Research, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
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The social outcomes of psychosocial support: A grey literature scoping review. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Spagnolo J, Naslund JA, Saeed K, Saxena S. Where are the regional gaps in the scientific evidence? Lancet Psychiatry 2021; 8:557-559. [PMID: 34147169 DOI: 10.1016/s2215-0366(21)00157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche Charles-Le Moyne-Saguenay-Lac-St-Jean sur les innovations en santé; Campus Longueuil-Université de Sherbrooke, Longueuil, QC J4K 0A8, Canada.
| | - John A Naslund
- Instructor in Global Health and Social Medicine, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Khalid Saeed
- Mental Health and Substance Abuse Unit, Department of Non-Communicable Diseases and Mental Health, WHO, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public, Boston, MA, USA
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