Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal

Abstract

Background.In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists.Methods.We implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of ‘Yes’ or ‘No’ questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback.Results.For each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components.Conclusion.Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants.

Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal

“…The study was conducted in the primary care outpatient clinic of Bayalpata Hospital, a district-level facility operated by Possible, a non-profit organization, in close partnership with the government of Nepal since 2008 [13]. The clinic is located in Achham, one of the poorest districts in Nepal that was severely affected by the 10year Maoist War that ended in 2006 [14].…”

“…A substantial shortage of mental healthcare providers in low-and middle-income countries (LMICs) [1] has left 75-80% of patients without even basic mental healthcare [2]. In Nepal, there are about 100 psychiatrists, most of them concentrated in urban areas, [3]. In such settings, a common strategy to expand access to mental healthcare is by using task-sharing, where non-specialists such as primary care providers (PCPs), deliver mental healthcare [4][5][6].…”

Collaborative Care for Mental Health in Low- and Middle-Income Countries: A WHO Health Systems Framework Assessment of Three Programs

“…We closely coordinate with local governing bodies and senior administrators to support PCP training and other tasks related to implementing the studies, reducing absenteeism, and enhancing accountability. We develop and implement mental health training for PCPs and measure gains with pre- and posttests (8). We emphasize the role of training and ongoing supervision from a psychiatrist to address PCP concerns about new tasks of prescribing and monitoring psychotropic medications.…”

Translating mental health diagnostic and symptom terminology to train health workers and engage patients in cross-cultural, non-English speaking populations

“…This assures organizational continuity across trainings and intervention programs. While implementing mental health care packages in government health services, developing psychoeducation materials and synergizing that language with training manuals helps to promote continuity across practitioners and between training and care provision, as was done by TPO Nepal [ 8 ] and Possible , a non-profit organization that delivers mental health services along with general healthcare based out of two district-level public hospitals in rural Nepal [ 9 ]. If terms for patients and the public are standardized in this way, it also allows for concerted efforts on awareness raising, increasing mental health literacy, reducing stigma, and promoting treatment engagement and adherence.…”

“…Even when health professionals have agreed upon common terminology for assessing symptoms and communicating about mental health with patients, families, and communities, it is important that the terms do not become conflated with disease and disorder without also evaluating functional impairment. As an illustration, when describing the specific symptom of hallucinations as part of a training module for psychosis [ 9 ], we received feedback from Nepali generalist clinicians practicing in Nepal that many traditional healers routinely report hearing voices from ancestors, spirits, and other supernatural beings and the clinicians wondered if that meant the healers had psychosis. The healers are not distressed by the symptom and do not have any other signs and symptoms of mental illness.…”