Are community mental health services relevant in low- and middle-income countries?

Thornicroft, Graham; Tansella, Michele

doi:10.1017/s2045796014000067

Cited by 10 publications

(7 citation statements)

References 49 publications

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“…A larger-scale study, for example, nested during the scale-up phase of PRIME, may need to be conducted. Although community mental health service provision 28 as it is known in the West is not feasible, PRIME is working to support integration of mental healthcare into the work of community health workers. The role of psychiatrists will also need to be redefined 29 so that they focus on service development and supporting policy.…”

Section: Discussionmentioning

confidence: 99%

Development of a scalable mental healthcare plan for a rural district in Ethiopia

et al. 2016

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BackgroundDeveloping evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority.AimsTo outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia.MethodA mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation).ResultsThe community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability.ConclusionsThe MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC.

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Section: Discussionmentioning

confidence: 99%

Development of a scalable mental healthcare plan for a rural district in Ethiopia

et al. 2016

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“…Third, in relation to role clarification, the human resource mix and associated skills sets and resources to achieve the plan are contained in Table 5 . Notwithstanding evidence of the effective use of lay health workers in other low- and middle-income countries to increase access to psychosocial interventions, 34 poor role clarification and marginalised status of existing lay counsellors in the South African healthcare system 35 resulted in two major difficulties: a lack of confidence and reticence to take on additional counselling duties on their part; and low referrals by primary healthcare nurses who did not trust their competencies to counsel patients effectively. This has been addressed in the implementation toolkit of the revised MHCP through: (a) more clearly identifying a case manager (primary healthcare nurse) responsible for monitoring patient progress at primary healthcare level (which has been a need identified in the MHCP in India 36 in this supplement); and (b) providing greater role clarification of lay counsellors.…”

Section: Discussionmentioning

confidence: 99%

Integrating mental health into chronic care in South Africa: The development of a district mental healthcare plan

et al. 2016

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BackgroundIn South Africa, the escalating prevalence of chronic illness and its high comorbidity with mental disorders bring to the fore the need for integrating mental health into chronic care at district level.AimsTo develop a district mental healthcare plan (MHCP) in South Africa that integrates mental healthcare for depression, alcohol use disorders and schizophrenia into chronic care.MethodMixed methods using a situation analysis, qualitative key informant interviews, theory of change workshops and piloting of the plan in one health facility informed the development of the MHCP.ResultsCollaborative care packages for the three conditions were developed to enable integration at the organisational, facility and community levels, supported by a human resource mix and implementation tools. Potential barriers to the feasibility of implementation at scale were identified.ConclusionsThe plan leverages resources and systems availed by the emerging chronic care service delivery platform for the integration of mental health. This strengthens the potential for future scale up.

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“…Global mental health experts have emphasised the need for community mental health teams and their ability to carry out a broad array of tasks such as identification, referrals, elementary counselling, family support and psychosocial interventions, if they are provided adequate training and periodic monitoring and support. 20 , 21 The role of psychiatrists also needs to undergo a fundamental paradigm shift and it is proposed that they should now play a major role in new core tasks such as designing mental healthcare programmes that can be delivered by these community mental health teams, capacity building and providing supportive supervision to members of these team. 22 …”

Section: Discussionmentioning

confidence: 99%

Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India

et al. 2016

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BackgroundThe large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care.AimsTo operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district.MethodMixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility.ResultsThe MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment.ConclusionsThere are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models.

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Are community mental health services relevant in low- and middle-income countries?

Cited by 10 publications

References 49 publications

Development of a scalable mental healthcare plan for a rural district in Ethiopia

Development of a scalable mental healthcare plan for a rural district in Ethiopia

Integrating mental health into chronic care in South Africa: The development of a district mental healthcare plan

Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India

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