Development and pilot testing of a mental healthcare plan in Nepal

Jordans, Mark J. D.; Luitel, Nagendra P.; Pokhrel, Pooja; Patel, Vinesh

doi:10.1192/bjp.bp.114.153718

Cited by 124 publications

(126 citation statements)

References 33 publications

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“…Patient sample sizes varied from 6524 in Haiti, to 1664 in Kenya,28 and staff sample sizes from 1126 in Nepal, to 360 in Ethiopia 23. Two studies described clinical applications of the mhGAP-IG using a mobile phone-operated ‘app.’ In Afghanistan,27 an android-based mobile application using the mhGAP-IG, developed by a private enterprise, had been pretested for functionality and acceptability at Aga Khan Health Services in Pakistan and Afghanistan.…”

Section: Resultsmentioning

confidence: 99%

WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries

Keynejad

Dua

Barbui

et al. 2017

Evid Based Mental Health

221

206

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Data were extracted from included papers, but heterogeneity prevented meta-analysis. Findings:We conducted a systematic review of evidence to date, of mhGAP-IG implementation and evaluation in LMICs. 33 included studies reported 15 training courses, nine clinical implementations, three country contextualisations, three economic models, two uses as control interventions and one use to develop a rating scale. Our review identified the importance of qualitative reports of contextual challenges in the field, alongside detailed protocols, qualitative studies and randomised controlled trials. Conclusions:The mhGAP-IG literature is substantial, relative to other published evaluations of clinical practice guidelines: an important contribution to a neglected field.3

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Section: Resultsmentioning

confidence: 99%

WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries

Keynejad

Dua

Barbui

et al. 2017

Evid Based Mental Health

221

206

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“…In Chitwan, 55.2% of participants (133 out of 241) accessed care, while the percentage in Pyuthan was 77.6 (208 out 268). The mental health services offered by trained primary health-care workers included pharmacological and psychosocial interventions 7 . Participants were mainly referred by female community health volunteers (84.9%) and civil society women’s groups (14.5%).…”

Section: Relevant Changesmentioning

confidence: 99%

Proactive community case-finding to facilitate treatment seeking for mental disorders, Nepal

Jordans

Kohrt

Luitel³

et al. 2017

Bull. World Health Organ.

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ProblemUnderutilization of mental health services is a major barrier to reducing the burden of disease attributable to mental, neurological and substance-use disorders. Primary care-based screening to detect people with mental disorders misses people not frequently visiting health-care facilities or who lack access to services.ApproachIn two districts in Nepal, we trained lay community informants to use a tool to detect people with mental, neurological and substance-use disorders during routine community service. The community informant detection tool consists of vignettes, which are sensitive to the context, and pictures that are easy to understand for low literacy populations. Informants referred people they identified using the tool to health-care facilities. Three weeks after detection, people were interviewed by trained research assistants to assess their help-seeking behaviour and whether they received any treatment.Local settingDecentralized mental health services are scarce in Nepal and few people with mental disorders are seeking care.Relevant changesOut of the 509 people identified through the community informant detection tool, two-thirds (67%; 341) accessed health services and 77% (264) of those individuals initiated mental health treatment. People in the rural Pyuthan district (208 out of 268) were more likely to access health care than those living in Chitwan district (133 out of 241).Lessons learntThe introduction of the tool increased the utilization of mental health services in a low-income country with few health resources. The tool seems beneficial in rural settings, where communities are close-knit and community informants are familiar with those in need of mental health services.

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“…Nepal has high rates of extreme poverty, child malnutrition, and migration and recent high exposure to conflict during the People’s War in Nepal (1996-2006) (UNICEF, 2006). As part of an ongoing project aiming to establish mental health care in Nepal (Jordans, Luitel, Pokharel, & Patel, 2015), our team has conducted formative research in order to understand stakeholders’ concerns related to child behavior problems and effectively target an intervention toward locally meaningful and acceptable goals (Burkey et al, 2015). …”

Section: Methodsmentioning

confidence: 99%

Development process of an assessment tool for disruptive behavior problems in cross-cultural settings: the Disruptive Behavior International Scale – Nepal version (DBIS-N)

Burkey

Ghimire²,

Adhikari³

et al. 2016

International Journal of Culture and Mental Health

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Systematic processes are needed to develop valid measurement instruments for disruptive behavior disorders (DBDs) in cross-cultural settings. We employed a four-step process in Nepal to identify and select items for a culturally valid assessment instrument: 1) We extracted items from validated scales and local free-list interviews. 2) Parents, teachers, and peers (n=30) rated the perceived relevance and importance of behavior problems. 3) Highly rated items were piloted with children (n=60) in Nepal. 4) We evaluated internal consistency of the final scale. We identified 49 symptoms from 11 scales, and 39 behavior problems from free-list interviews (n=72). After dropping items for low ratings of relevance and severity and for poor item-test correlation, low frequency, and/or poor acceptability in pilot testing, 16 items remained for the Disruptive Behavior International Scale—Nepali version (DBIS-N). The final scale had good internal consistency (α=0.86). A 4-step systematic approach to scale development including local participation yielded an internally consistent scale that included culturally relevant behavior problems.

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Development and pilot testing of a mental healthcare plan in Nepal

Cited by 124 publications

References 33 publications

WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries

WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries

Proactive community case-finding to facilitate treatment seeking for mental disorders, Nepal

Development process of an assessment tool for disruptive behavior problems in cross-cultural settings: the Disruptive Behavior International Scale – Nepal version (DBIS-N)

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