Barriers and Drivers to Service Delivery in Global Mental Health Projects

Abstract

Background: Research within global mental health (GMH) has extensively documented how contextual factors like political instability, poverty and poorly-funded health infrastructures continue to compromise effective and equitable mental health service delivery. There is a need to develop more feasible and evidence-based solutions through implementation research. This paper, one in a series pertaining to implementation in GMH projects worldwide, focuses on implementation factors influencing mental health service delivery.Methods: This is a qualitative study carried out as part of a Theory of Change-driven evaluation of Grand Challenges Canada’s (GCC’s) global mental health portfolio. Purposive sampling was used to recruit twenty-nine GCC grantees for interviews. A semi-structured interview schedule was used to guide the interviews which were recorded and subsequently transcribed. Transcripts were double-coded and analyzed in NVIVO 11 using framework analysis. This paper reports results related to detection and treatment of mental illness, mental health promotion and prevention of mental illness.Results: Key barriers included: lack of appropriate human resources and expertise for service delivery; lack of culturally appropriate screening tools and interventions; and difficulties integrating services with the existing mental health system. Formative research was a key driver facilitating the cultural adaptation of mental health detection, treatment, promotion and preventative approaches. Recruiting local providers and utilizing mHealth for improving screening, monitoring and data management were also found to be successful approaches in reducing workforce burden, improving sustainability, mental health literacy, participant engagement and uptake.Conclusions: The study identifies a number of key barriers to and drivers of successful service delivery from the perspective of grantees implementing GMH projects. Findings highlight several opportunities to mitigate common challenges, providing recommendations for strengthening systems- and project-level approaches for delivering mental health services. Further, more inclusive research is required to inform guidance around service delivery for successful implementation, better utilization of funding and improving mental health outcomes among vulnerable populations in low-resource settings.

Barriers and drivers to stakeholder engagement in global mental health projects

“…These factors point to the importance of communication and awareness-raising about mental health and mental health services as a means of increasing engagement. Despite this fact, few of the programs included in this study included mental health promotion and awareness components [ 22 ] . This indicates a need for improved communication for mental health awareness-raising among stakeholders.…”

“…Each of three members of the study team (JM, OQ and TE) initially identified themes, and subsequently discussed and refined them until consensus was achieved. This paper presents findings for the stakeholder engagement cluster, with results from the other two clusters published as part of this series [ 22 , 23 ].…”

Lessons from a theory of change-driven evaluation of a global mental health funding portfolio

“…Over- or under-estimating the level of demand for services was a commonly faced barrier to successful delivery for grantees [ 23 ]. Reliance on isolated prevalence estimates [ 33 ], lack of appropriate epidemiological statistics on population mental health [ 34 ], limited understanding of the attitudes on help seeking for mental health [ 35 ], fragmented routine data around existing service use [ 36 ], and lack of validation of screening tools [ 37 ] could all be contributing factors.…”

“…However, qualifying in advance what success at each step on the pathway should look like would also have been problematic. The variation we observed among project targets set by grantees suggests that these were not well-defined from the outset, an issue explored further in Qureshi et al [ 23 ]. Importantly, the extent to which targets were achieved did not necessarily reflect the degree to which implementation was successful.…”

“…In this paper, we share descriptive results of a quantitative analysis of the GCC portfolio’s Core Metrics data, and examine the strengths and limitations of a ToC-driven approach to portfolio-level evaluation, for which there is very little practical guidance currently available [ 16 ]. Related papers by Endale et al [ 21 ], Murphy et al [ 22 ] and Qureshi et al [ 23 ] in this series describe the qualitative components of this evaluation, with a focus on barriers and facilitators to successful implementation across three key areas: (i) stakeholder engagement; (ii) capacity building; and (iii) service delivery. Our aim is to harness and share learning from one of the biggest investments in global mental health to-date, relevant both to funders like GCC and to implementers working in the field.…”