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Objectives The WHO's Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) has been widely used in low and middle-income countries. We reviewed literature describing interventions and training programmes beyond the mhGAP-IG, in primary healthcare (PHC) and community-based healthcare (CBH). Design We searched studies excluded from our updated mhGAP-IG systematic review, and included in other relevant systematic reviews, for evidence and experience of initiatives integrating mental health into PHC and CBH. Our 24 November 2020 mhGAP-IG search encompassed MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie and Google Scholar. Although heterogeneity prevented meta-analysis, we descriptively summarised the evidence-base. Results Out of 1827 results, we identified 208 relevant records. They described randomised controlled trials of mental health interventions (98 studies, n=55 523 participants), non-randomised studies measuring clinical outcomes (22 studies, n=7405), training outcomes (36 studies, n=12 280) and implementation outcomes (21 studies, n=1090), plus descriptive accounts (18 studies, n=2526), baseline surveys and exploratory studies (6 studies, n=17 093) and commentaries (7 studies). Most (40%) were conducted in the African region, region of the Americas (16%), and South-East Asia (13%). Randomised and non-randomised studies reported improved symptoms, substance use, functioning, parenting and child outcomes. Non-randomised studies reported improved clinical knowledge, confidence and skills following training. Conclusions The literature beyond the mhGAP-IG is extensive and shares common findings. Future priorities are less-studied regions, interventions for severe mental illness, exploring ways that mhGAP-IG and alternative approaches complement each other in different contexts and scaling-up mental health integration. PROSPERO registration number CRD42017068459. [ABSTRACT FROM AUTHOR]

Question Despite mental, neurological and substance use (MNS) disorders being highly prevalent, there is a worldwide gap between service need and provision. WHO launched its Mental Health Gap Action Programme (mhGAP) in 2008, and the Intervention Guide (mhGAP-IG) in 2010. mhGAPIG provides evidence-based guidance and tools for assessment and integrated management of priority MNS disorders in low and middle-income countries (LMICs), using clinical decision-making protocols. It targets a non-specialised primary healthcare audience, but has also been used by ministries, non-governmental organisations and academics, for mental health service scale-up in 90 countries. This review aimed to identify evidence to date for mhGAP-IG implementation in LMICs. Study selection and analysis We searched MEDLINE, Embase, PsycINFO, Web of Knowledge/Web of Science, Scopus, CINAHL, LILACS, SciELO/ Web of Science, Cochrane, Pubmed databases and Google Scholar for studies reporting evidence, experience or evaluation of mhGAP-IG in LMICs, in any language. 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. Thirty-three included studies reported 15 training courses, 9 clinical implementations, 3 country contextualisations, 3 economic models, 2 uses as control interventions and 1 use to develop a rating scale. Our review identified the importance of detailed 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. [ABSTRACT FROM AUTHOR]

Objective To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission or treatment. Design Single blind randomised controlled trial,with randomisation of individual patients.The investigator was blind to allocation. Setting Eight community mental health teams in southern England. Participants 160 people with an operational diagnosis of psychotic illness or non-psychotic bipolar disorder who had experienced a hospital admission within the previous two years. Intervention The joint crisis plan was formulated by the patient,care coordinator,psychiatrist,and project worker and contained contact information,details of mental and physical illnesses,treatments,indicators for relapse,and advance statements of preferences for care in the event of future relapse. Main outcome measures Admission to hospital,bed days,and use of the Mental Health Act over 15 month follow up. Results Use of the Mental Health Act was significantly reduced for the intervention group,13%(10/80)of whom experienced compulsory admission or treatment compared with 27%(21/80)of the control group (risk ratio 0.48,95%confidence interval 0.24 to 0.95,P =0.028).As a consequence,the mean number of days of detention (days spent as an inpatient while under a section of the Mental Health Act)for the whole intervention group was 14 compared with 31 for the control group (difference 16,0 to 36,P =0.04).For those admitted under a section of the Mental Health Act,the number of days of detention was similar in the two groups (means 114 and 117,difference 3,-61 to 67,P =0.98).The intervention group had fewer admissions (risk ratio 0.69,0.45 to 1.04,P =0.07).There was no evidence for differences in bed days (total number of days spent as an inpatient)(means 32 and 36,difference 4,-18 to 26,P =0.15 for the whole sample;means 107 and 83,difference -24,-72 to 24, P =0.39... [ABSTRACT FROM AUTHOR]

Focuses on the policy enacted by the World Health Organization's (WHO) "Mental Health Declaration for Europe" and "Mental Health Action Plan for Europe," which were endorsed by 52 member states in the European region of the WHO. Consultation of organizations of service users, non-governmental organizations and professionals to prepare the statements; Degree of institutionalization that still exists in West and East European countries; Declaration of WHO that mental health services in Europe should be provided in a range of community based settings, not large, isolated institutions.

The authors reflect on the improvement of mental health systems to meet the needs of people with mental illness. They promote a peaceful and inclusive societies for sustainable development to enhanced the quality of care in mental health. The authors note that the national governments and international donors prioritized the provision of mental and physical health and social care services for people with mental disorders.