Barriers and drivers to service delivery in global mental health projects

Abstract

Background Research in global mental health (GMH) has previously documented how contextual factors like political instability, poverty and poorly-funded health infrastructure 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.

Supporting community-based mental health initiatives: insights from a multi-country programme and recommendations for funders

“…Initiatives also reported critical funding situations threatening their sustainability, which could not always be resolved within the 1-year partnership period. These reports resonate with other accounts of global mental health projects operating in low-resource settings 27 and highlight the strain that underinvestment in mental health-a widely recognised issue since the field's early days 29 -places on those working on the ground. Expanding investment into CBMHIs across diverse contexts 30 must be accompanied by longer funding cycles and further diversification of the mechanisms by which funding is currently granted.…”

“…27 Initiatives also appreciated the relationships forged with other organisations from the Ember cohort and gaining access to broader global mental health networks. Fostering collaboration within this field, including opportunities for conversation and knowledge exchange between organisations, should be an immediate priority for funders to support initiatives to thrive.…”

Integration of nutrition assessment counselling and support interventions in health service delivery and respective drivers: A case study of Tororo district, Uganda

“…Besides, although partner support facilitated integration, it was observed that this support might be unsustainable. Several studies have revealed similar challenges of sustainability of interventions due to donor driven projects [32][33][34][35]. This implies that sustained implementation of nutrition interventions requires reasonable nancial contribution from government.…”

Feasibility and acceptability of written exposure therapy in addressing posttraumatic stress disorder in Iranian patients with breast cancer

“…In LMICs the increasing burden of cancer further strains struggling health care systems 1 and mental health service delivery is significantly limited by fragmented health systems, lack of highly-skilled practitioners, and inadequate resources for highly complex psychological interventions. 15 Thus, in LMICs there is an even greater need for psycho-oncological interventions that are evidence-based, low intensity, and widely and freely available. 16 The aim of this study was to examine the feasibility and acceptability of WET among Iranian women with breast cancer and cancer-related PTSD.…”