1. Impact of integrated district level mental health care on clinical and social outcomes of people with severe mental illness in rural Ethiopia: an intervention cohort study.
- Author
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Hanlon C, Medhin G, Selamu M, Birhane R, Dewey M, Tirfessa K, Garman E, Asher L, Thornicroft G, Patel V, Lund C, Prince M, and Fekadu A
- Subjects
- Adult, Affective Disorders, Psychotic diagnosis, Affective Disorders, Psychotic physiopathology, Bipolar Disorder diagnosis, Bipolar Disorder physiopathology, Cohort Studies, Community Mental Health Services organization & administration, Delivery of Health Care, Ethiopia, Female, Humans, Male, Middle Aged, Prejudice, Psychotic Disorders diagnosis, Psychotic Disorders physiopathology, Regional Health Planning, Restraint, Physical, Rural Population, Schizophrenia diagnosis, Schizophrenia physiopathology, Severity of Illness Index, Social Stigma, Young Adult, Affective Disorders, Psychotic therapy, Bipolar Disorder therapy, Community Mental Health Services methods, Primary Health Care methods, Psychiatric Nursing, Psychotic Disorders therapy, Schizophrenia therapy
- Abstract
Aim: There is limited evidence of the safety and impact of task-shared care for people with severe mental illnesses (SMI; psychotic disorders and bipolar disorder) in low-income countries. The aim of this study was to evaluate the safety and impact of a district-level plan for task-shared mental health care on 6 and 12-month clinical and social outcomes of people with SMI in rural southern Ethiopia., Methods: In the Programme for Improving Mental health carE, we conducted an intervention cohort study. Trained primary healthcare (PHC) workers assessed community referrals, diagnosed SMI and initiated treatment, with independent research diagnostic assessments by psychiatric nurses. Primary outcomes were symptom severity and disability. Secondary outcomes included discrimination and restraint., Results: Almost all (94.5%) PHC worker diagnoses of SMI were verified by psychiatric nurses. All prescribing was within recommended dose limits. A total of 245 (81.7%) people with SMI were re-assessed at 12 months. Minimally adequate treatment was received by 29.8%. All clinical and social outcomes improved significantly. The impact on disability (standardised mean difference 0.50; 95% confidence interval (CI) 0.35-0.65) was greater than impact on symptom severity (standardised mean difference 0.28; 95% CI 0.13-0.44). Being restrained in the previous 12 months reduced from 25.3 to 10.6%, and discrimination scores reduced significantly., Conclusions: An integrated district level mental health care plan employing task-sharing safely addressed the large treatment gap for people with SMI in a rural, low-income country setting. Randomised controlled trials of differing models of task-shared care for people with SMI are warranted.
- Published
- 2019
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