Abstract
BackgroundDespite many important developments in the global mental health arena in the past decade, many people with mental health problems still do not have access to good quality mental health care. The aim of this study was to evaluate the perceived impact of a mental health care package (MHCP) in integrating chronic care elements in primary health care for people with mental illness.MethodsA controlled pre-post study design was used in 20 primary health care facilities in Chitwan, Nepal. We compared 10 health facilities that had implemented a MHCP (intervention group), with 10 health facilities that had not implemented the MHCP (comparative control group) but provided regular physical health services. We administered the Assessment of Chronic Illness Care (ACIC) tool on a group basis within all 20 health facilities among 37 health workers. Data was collected at three time points; at baseline, midline (at 13 months from baseline) and end line (at 25 months from baseline).ResultsFrom baseline to end line, we see a notable shift in the level of support reported by the intervention health facilities compared to those in the comparative control group. While at baseline 10% of the intervention health facilities had basic support for the implementation of chronic illness care, at the end line, 90% of the intervention group reported having reasonable support with the remaining 10% of the intervention facilities reporting that they had full support. In contrast, 20% of the health facilities in the comparative control group at end line still reported having limited support for the implementation of chronic illness care, with the remaining 80% only managing to shift to the next level which is basic support.ConclusionsThese findings suggest that training and supervision of primary health care workers in the implementation of MHCP interventions can lead to strengthening of the system to better address the needs of patients with chronic mental health problems. However, substantial financial and coordination inputs are needed to implement the MHCP. The comparative control group also demonstrated improvements, possibly due to the administration of the ACIC tool and components of counselling services for family planning and HIV/AIDS services.
Highlights
Despite many important developments in the global mental health arena in the past decade, many people with mental health problems still do not have access to good quality mental health care
Upadhaya et al BMC Health Services Research (2020) 20:632 (Continued from previous page). These findings suggest that training and supervision of primary health care workers in the implementation of mental health care package (MHCP) interventions can lead to strengthening of the system to better address the needs of patients with chronic mental health problems
The Assessment of Chronic Illness Care (ACIC) was repeated at 13 months to establish whether there was any change in the mean scores after the implementation of the MHCP intervention
Summary
Despite many important developments in the global mental health arena in the past decade, many people with mental health problems still do not have access to good quality mental health care. The past decade has seen many important contributions in the global mental health arena, including the Lancet series 2007 and 2011 on mental health, the Inter Agency Standing Committee guidelines for Mental Health and Psychosocial Support in emergency settings, and World Health Organization (WHO)'s Mental Health Gap Action Program (mhGAP) [1] Despite this progress, globally the gap between the number of people who have a mental disorder and those who receive treatment for their disorder remains high and is commonly referred to as the ‘treatment gap’ [2]. The WHO’s World Mental Health Survey reported that between 76.3 to 85.4% of severe mental health cases in less-developed countries received no treatment 12 months preceding participation in the survey [4] One explanation for this high treatment gap is the lack of trained human resources in mental health. A metaanalysis finds that all low income countries and 59% of middle income countries had far fewer mental health professionals than what was needed [5]
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