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.

Rahul Shidhaye,Crick Lund,Dan Chisholm

doi:10.1186/s13033-015-0031-9

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.

Highlights

A large proportion of persons affected by mental, neurological and substance use (MNS) disorders do not have access to a wide variety of evidence-based interventions which can prevent and treat these disorders, resulting in a huge treatment gap [1]
In the real-world setting, implementation of evidencebased interventions for MNS disorders seldom occurs through the delivery of single vertical interventions, rather these interventions are delivered via so-called platforms—the level of the health or welfare system at which interventions or packages can be most appropriately, effectively, and efficiently delivered [4]
Nested within the wider health systems strengthening approach, we describe a number of specific strategies for integrated mental health care delivery, but is should be borne that they are context-specific and may not be generalizable in all settings

Summary

Introduction

A large proportion of persons affected by mental, neurological and substance use (MNS) disorders do not have access to a wide variety of evidence-based interventions which can prevent and treat these disorders, resulting in a huge treatment gap [1]. It is to these delivery platforms or channels that resources are often allocated in practice, for example, to schools or primary health care services, rather than to specific interventions or disorders.

Results

Conclusion