Abstract
BackgroundIn low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Intervention Guide (IG), developed by the World Health Organization (WHO), aim to address this challenge by training non-specialists such as general practitioners (GPs) in mental health care. This trial aims to implement and evaluate an adapted version of the mhGAP-IG (version 1.0) offered to GPs in 2 governorates of Tunisia (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design before country-wide implementation and evaluation.Methods/DesignFirst, a systematic review will be conducted to explore types and effectiveness of mental health training programs offered to GPs around the world, with a specific focus on programs implemented and evaluated in LMICs. Second, a cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the implemented training based on the mhGAP-IG (version 1.0). Third, multiple case study design will be used to explore how contextual factors impact the successful implementation of the training and desired outcomes.DiscussionIn Tunisia, an important need exists to further develop proximity health services and to address the growing mental health treatment gap. One solution is to train GPs in the detection, treatment, and management of mental health problems, given their strategic role in the healthcare system. This trial thus aims to implement and evaluate an adapted version of a training based on the mhGAP-IG (version 1.0) in Tunis and Sousse before country-wide implementation and evaluation. Several contributions are envisioned: adding to the growing evidence on the mhGAP and its accompanying guide, especially in French-speaking nations; building research capacity in Tunisia and more generally in LMICs by employing rigorous designs; evaluating an adapted version of the mhGAP-IG (version 1.0) on a sample of GPs; generating important information regarding implementation process and study design before country-wide implementation; and complimenting the trial results with implementation analysis, a priority in global mental health.
Highlights
In low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health
The main objective of the trial is divided into 3 phases: Phase 1 aims to answer the following research question by conducting a systematic review: 1) What types of mental health training programs offered to general practitioners (GPs) have been implemented and evaluated, and are they effective? This review, which to our knowledge has not yet been previously conducted, will: 1) help us gain a broader perspective on tested training outcomes, in order to inform this trial; 2) compliment already available findings on the Mental Health Gap Action Programme (mhGAP)-Intervention Guide (IG); and 3) compare the effectiveness of a mental health training based on the mhGAP-IG with previously implementing training programs in LMICs
Coding from two independent reviewers will be merged, generating a percentage score for inter-rater reliability. The purpose of this trial is to implement and evaluate a training based on the mhGAP-IG offered to GPs in 2 Tunisian governorates (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design
Summary
In low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. High prevalence of mental disorders, a reliance on limited and unevenly distributed specialists, and neglect of adequate investment in resources allocated to mental health have prevented between 76-85% of people living with mental health problems in LMICs from receiving any treatment [4,5,6,7,8,9]. This treatment gap, which is on the rise in LMICs, points to the dire need of developing proximity mental health services for a population “ among the most neglected and vulnerable throughout the world” [10]. International efforts are assuming this approach because of its concordance with the realities of LMICs - it emphasizes the need to involve primary healthcare professionals and/or the lay workforce given the limited number and unequal distribution of mental health specialists [5, 18, 24, 25, 28]
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