Abstract
BackgroundThe burden of mental disorders in low- and middle-income countries is large. Yet there is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care.AimWe aimed to evaluate the impact of a district mental health care plan (MHCP) on contact coverage for and detection of mental disorders, as well as impact on mental health symptom severity and individual functioning in rural Uganda.ResultsFor adults who attended primary care facilities, there was an immediate positive effect of the MHCP on clinical detection at 3 months although this was not sustained at 12 months. Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment over 12 months. There was negligible change in population-level contact coverage for depression and alcohol use disorder.ConclusionThe study found that it is possible to integrate mental health care into primary care in rural Uganda. Treatment by trained primary care workers improves clinical and functioning outcomes for depression, psychosis and epilepsy. Challenges remain in accessing the men for care, sustaining the improvement in detection over time, and creating demand for services among those with presumed need.
Highlights
There is increasing recognition of the growing prevalence and impact of mental illness in low and middle income countries (LMICs)
Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment
Our study demonstrated that in a real-world complex evaluation, mental health treatment provided by trained and supervised primary health care workers can lead to improvement in symptom severity and functioning of patients with depression and epilepsy, and in functioning in patients with psychosis
Summary
There is increasing recognition of the growing prevalence and impact of mental illness in low and middle income countries (LMICs). The prevalence of mental disorders in Uganda is believed to Primary care plays a pivotal role in treating mental health conditions. Many patients with symptoms of mental distress are primarily and often exclusively seen by general practitioners in primary health care settings [5]. The World Health Organization (WHO) recommends the integration of care of mental health conditions into primary care by shifting care from specialist (i.e. psychiatrists, psychiatric nurses, psychologists) to generalist providers. The integration of mental health into primary health care enhances access, promotes respect of human. The burden of mental disorders in low- and middle-income countries is large. There is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care
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