Abstract
BackgroundLittle is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.MethodsA situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts.ResultsThe PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care.ConclusionsThe low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
Highlights
The unmet need for mental health care is high in most low- and middle-income countries (LMICs) [1,2]
In order to maximise the beneficial impact of mental health Gap Action Programme (mhGAP), due attention needs to be paid to the process of ‘how to’ successfully implement and scale-up of mental health care in primary health care (PHC) [13]
We present an analysis of common issues faced by the differently resourced PRogramme for Improving Mental health carE (PRIME) country districts in order to highlight the challenges and opportunities for integrating mental health into primary care across settings
Summary
The unmet need for mental health care is high in most low- and middle-income countries (LMICs) [1,2]. The consequences of untreated mental disorders include suffering, diminished quality of life and disability [4], human rights abuses, stigma and discrimination [5], poverty [6], poor physical health and premature mortality [7]. In response to this gross neglect of people with mental disorders, the World Health Organization (WHO) launched the mental health Gap Action Programme (mhGAP) which advocates scaling up of mental health care through integration into primary health care (PHC) and general medical services [8]. The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care
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