Abstract
BackgroundResearch in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery. There is a need to develop more feasible and evidence-based solutions through implementation research. This paper, one in a series pertaining to implementation in GMH projects worldwide, focuses on implementation factors influencing mental health service delivery.MethodsThis is a qualitative study carried out as part of a Theory of Change-driven evaluation of Grand Challenges Canada’s (GCC’s) Global Mental Health portfolio. Purposive sampling was used to recruit twenty-nine GCC grantees for interviews. A semi-structured interview schedule was used to guide the interviews which were recorded and subsequently transcribed. Transcripts were double-coded and analyzed in NVivo 11 using framework analysis. This paper reports results related to detection and treatment of mental illness, mental health promotion and prevention of mental illness.Results Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system. Formative research was a key driver facilitating the cultural adaptation of mental health detection, treatment, promotion and preventative approaches. Recruiting local providers and utilizing mHealth for improving screening, monitoring and data management were also found to be successful approaches in reducing workforce burden, improving sustainability, mental health literacy, participant engagement and uptake.ConclusionsThe study identifies a number of key barriers to and drivers of successful service delivery from the perspective of grantees implementing GMH projects. Findings highlight several opportunities to mitigate common challenges, providing recommendations for strengthening systems- and project-level approaches for delivering mental health services. Further, more inclusive research is required to inform guidance around service delivery for successful implementation, better utilization of funding and improving mental health outcomes among vulnerable populations in low-resource settings.
Highlights
Research in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery
A commonly reported barrier in the literature on GMH implementation is the shortage and unequal distribution of human resources for providing mental health services, which is more pronounced in low- and middle-income countries (LMICs) [3,4,5,6]
This paper describes results of a qualitative analysis of barriers and drivers to the implementation of service delivery in projects across Grand Challenges Canada (GCC)’s GMH funding portfolio [13, 14, 15]
Summary
Research in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure continue to compromise effective and equitable mental health service delivery. Depending on the severity of the condition, the frequency of need, Qureshi et al Int J Ment Health Syst (2021) 15:14 contextual considerations and human resource requirements and costs, service delivery can take place in different settings. These may include community-based settings such as homes, social welfare centres, local clinics, and schools; more general healthcare or specialist settings, mainly hospitals; or through projects with a preventative or mental health promotion approach [2]. Ensuring the appropriateness of mental health interventions through formative research to understand and incorporate culturally and contextually appropriate approaches to mental health, well-being and recovery have been identified as important considerations for successful mental health service delivery [8,9,10]
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