Tailoring a training based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) to Tunisia: process and relevant adaptations

Abstract

BackgroundIn order to make mental health services more accessible, the Tunisian Ministry of Health, in collaboration with the School of Public Health at the University of Montreal, the World Health Organization office in Tunisia and the Montreal World Health Organization-Pan American Health Organization Collaborating Center for Research and Training in Mental Health, implemented a training programme based on the Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) (version 1.0), developed by the World Health Organization. This article describes the phase prior to the implementation of the training, which was offered to general practitioners working in primary care settings in the Greater Tunis area of Tunisia.MethodsThe phase prior to implementation consisted of adapting the standard mhGAP-IG (version 1.0) to the local primary healthcare context. This adaptation process, an essential step before piloting the training, involved discussions with stakeholder groups, as well as field observations.ResultsThrough the adaptation process, we were able to make changes to the standard training format and material. In addition, the process helped uncover systemic barriers to effective mental health care.ConclusionsTargeting these barriers in addition to implementing a training programme may help reduce the mental health treatment gap, and promote implementation that is successful and sustainable.

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

“…While it is encouraging to note that PCPs in our sample do engage in mental health care, identified gaps in mental health knowledge, attitudes, and self-efficacy, as well as associations between certain characteristics and such competencies uncovered by simple linear regression models, seem to support two mental health initiatives confirmed in Tunisia: the implementation of a mental health training program in the Greater Tunis area, under the auspices of the Committee for Mental Health Promotion [ 23 , 39 , 78 ], and the recent inclusion of a mandatory (previously optional) 2-month internship in post-graduate medical curricula to train future PCPs in effective mental health detection, treatment, and management [ 91 ]. Continuing mental health training and a mandatory mental health internship with access to support and guidance to encourage positive contact and interaction with people living with mental health issues are thus strategies that Tunisia has adopted to help build non-specialists’ competencies in mental health.…”

“…The ongoing drafting of national substance use and suicide prevention strategies, as well as the implementation of national anti-stigma campaigns monitored by the Committee for Mental Health Promotion at the level of the Ministry of Health, aim to further promote the recognition of substance use disorders, self-harm, and suicide in Tunisia, as these conditions continue to be heavily stigmatized in the country [ 23 , 39 , 78 ]. Stigmatization may lead to disinterest, especially among primary care staff, underdiagnoses and/or under-reporting, limited options for treatment beyond specialized care, and few research initiatives in the field [ 79 , 80 ].…”

“…Stigmatization may lead to disinterest, especially among primary care staff, underdiagnoses and/or under-reporting, limited options for treatment beyond specialized care, and few research initiatives in the field [ 79 , 80 ]. Thus, referral of patients presenting with substance use disorders, suicide/self-harm, and psychosis (including schizophrenia) is still very common in Tunisia [ 78 ], limiting PCPs’ contact and involvement with these conditions in primary care, as shown in our sample.…”

Challenges and lessons learned in re-filming the WHO mhGAP training videos for Sri Lankan context - a qualitative study

“…Research suggests the mhGAP programme may require further consultation with local stakeholders, particularly service users, to ensure it is culturally appropriate [9]. Some research studies on its implementation have illustrated and reflected on adaptations made, for example on the change of content to better fit the epidemiology of the setting or on translation and rearrangement of the chapter flow [10,11]. In all settings the input from local practitioners and stakeholders is considered essential to the process of adaptation to ensure best fit with local expressions of mental distress, cultural practices, and most frequently encountered issues in clinical practice.…”

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

“…Although Tunisia is equipped with mental health services, they are mainly provided in the capital (through the only standing and overcrowded mental health hospital in the country) and along the coastline (through psychiatric units within regional hospitals), making the distribution of resources uneven and impeding on equal access to services [43, 44]. In addition, Tunisia suffers from a shortage of mental health professionals, such as psychiatrists, psychologists, psychiatric nurses, and mental health social workers [41, 43] also echoed in many other LMICs.…”