Scaling Up for the “Bottom Billion”: “5×5” Implementation of Community Mental Health Care in Low-Income Regions

Belkin, Gary S.; Unützer, Jürgen; Kessler, Ronald C.; Verdeli, Helen; Raviola, Giuseppe; Sachs, Katherine; Oswald, Catherine; Eustache, Eddy

doi:10.1176/appi.ps.000012011

Cited by 61 publications

(62 citation statements)

References 56 publications

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“…Recent mental health development efforts in Haiti are characterized by practical application of psychological constructs and systematic approaches to scaling up models of care (Belkin, Unützer, Kessler, Verdeli et al, 2011; Raviola, Eustache, Oswald & Belkin, 2012). The community-based mental health model proposed by ZL is one such program (for more detail, see Raviola et al, 2012).…”

mentioning

confidence: 99%

Development and validation of a Haitian Creole screening instrument for depression

Rasmussen

Eustache²,

Raviola

et al. 2014

Transcult Psychiatry

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Developing mental health care capacity in post-earthquake Haiti is hampered by the lack of assessments that include culturally bound idioms Haitians use when discussing emotional distress. The current study describes a novel emic-etic approach to developing a depression screening for Partners In Health/Zanmi Lasante. In Study 1 Haitian key informants were asked to classify symptoms and describe categories within a pool of symptoms of common mental disorders. Study 2 tested the symptom set that best approximated depression in a sample of depressed and not depressed Haitians in order to select items for the screening tool. The resulting 13-item instrument produced scores with high internal reliability that were sensitive to culturally-informed diagnoses, and interpretations with construct and concurrent validity (vis-à-vis functional impairment). Discussion focuses on the appropriate use of this tool and integrating emic perspectives into developing psychological assessments globally. The screening tool is provided as an Appendix.

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mentioning

confidence: 99%

Development and validation of a Haitian Creole screening instrument for depression

Rasmussen

Eustache²,

Raviola

et al. 2014

Transcult Psychiatry

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“…IPT can be effectively delivered by a variety of health providers from mental health specialties such as psychiatrists, psychologists, nurses, social workers, and occupational therapists; to trained lay health workers (10). This range of treatment providers can help to address the wide global gap between the need for, and access to, mental health care (11,12).…”

Section: Eating Disorders and Interpersonal Problemsmentioning

confidence: 99%

Interpersonal Psychotherapy: Healing with a Relational Focus

Ravitz¹,

Watson²

2014

FOC

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Interpersonal psychotherapy (IPT) is a time-limited psychotherapy that focuses on relationship stressors and ways to adaptively engage with social supports. Since the first controlled IPT depression study 40 years ago, new applications of the model have emerged, informed by research and public health needs. Evidence for its effectiveness has led to its inclusion in expert consensus treatment guidelines for the treatment of depression, eating disorders, and bipolar disorder. This paper provides a clinical synthesis of IPT, reviewing adaptations that include: IPT-A, for use with adolescents with depression; interpersonal social rhythm therapy (IPSRT), for patients with bipolar disorder; IPT, for patients with eating disorders; and IPT, for patients with depression in culturally diverse settings. With its clear clinical guidelines, therapist-and patient-friendly approach, and data supporting its effectiveness, IPT is easily integrated into mental health care to help patients with mood or eating disorders and interpersonal problems.

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“…Last, most mental health training programs are not designed in the form of a ‘package,’ where training is complimented with guidelines that seek to develop mental health policies and systems [17, 26]. These guidelines are important because they can help decision-makers orchestrate and sustain reforms [7, 26, 37]. …”

Section: Introductionmentioning

confidence: 99%

Building system capacity for the integration of mental health at the level of primary care in Tunisia: a study protocol in global mental health

Spagnolo

Champagne

Leduc

et al. 2017

BMC Health Serv Res

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BackgroundIn low- and middle-income countries (LMICs), addressing the high prevalence of mental disorders is a challenge given the limited number and unequal distribution of specialists, as well as scarce resources allocated to mental health. The Mental Health Gap Action Programme (mhGAP) and its accompanying Intervention Guide (IG), developed by the World Health Organization (WHO), aim to address this challenge by training non-specialists such as general practitioners (GPs) in mental health care. This trial aims to implement and evaluate an adapted version of the mhGAP-IG (version 1.0) offered to GPs in 2 governorates of Tunisia (i.e., Tunis and Sousse), in order to uncover important information regarding implementation process and study design before country-wide implementation and evaluation.Methods/DesignFirst, a systematic review will be conducted to explore types and effectiveness of mental health training programs offered to GPs around the world, with a specific focus on programs implemented and evaluated in LMICs. Second, a cluster randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the implemented training based on the mhGAP-IG (version 1.0). Third, multiple case study design will be used to explore how contextual factors impact the successful implementation of the training and desired outcomes.DiscussionIn Tunisia, an important need exists to further develop proximity health services and to address the growing mental health treatment gap. One solution is to train GPs in the detection, treatment, and management of mental health problems, given their strategic role in the healthcare system. This trial thus aims to implement and evaluate an adapted version of a training based on the mhGAP-IG (version 1.0) in Tunis and Sousse before country-wide implementation and evaluation. Several contributions are envisioned: adding to the growing evidence on the mhGAP and its accompanying guide, especially in French-speaking nations; building research capacity in Tunisia and more generally in LMICs by employing rigorous designs; evaluating an adapted version of the mhGAP-IG (version 1.0) on a sample of GPs; generating important information regarding implementation process and study design before country-wide implementation; and complimenting the trial results with implementation analysis, a priority in global mental health.

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Scaling Up for the “Bottom Billion”: “5×5” Implementation of Community Mental Health Care in Low-Income Regions

Cited by 61 publications

References 56 publications

Development and validation of a Haitian Creole screening instrument for depression

Development and validation of a Haitian Creole screening instrument for depression

Interpersonal Psychotherapy: Healing with a Relational Focus

Building system capacity for the integration of mental health at the level of primary care in Tunisia: a study protocol in global mental health

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