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Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries
- Source :
- PLoS ONE, Vol 9, Iss 2, p e88437 (2014), PLoS One, PLoS ONE, Hanlon, C, Luitel, N P, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, Ssebunnya, J, Fekadu, A, Shidhaye, R, Petersen, I, Jordans, M, Kigozi, F, Thornicroft, G, Patel, V, Tomlinson, M, Lund, C, Breuer, E, De Silva, M & Prince, M 2014, ' Challenges and opportunities for implementing integrated mental health care : a district level situation analysis from five low-and middle-income countries ', PLoS ONE, vol. 9, no. 2, e88437 . https://doi.org/10.1371/journal.pone.0088437
- Publication Year :
- 2014
- Publisher :
- Public Library of Science (PLoS), 2014.
-
Abstract
- BackgroundLittle is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.MethodsA situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts.ResultsThe PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care.ConclusionsThe low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.
- Subjects :
- Program evaluation
Economic growth
Non-Clinical Medicine
Epidemiology
lcsh:Medicine
HIV Infections
Global Health
Social and Behavioral Sciences
Health Services Accessibility
South Africa
Sociology
Psychology
Mental health and psychiatry
Uganda
Health Systems Strengthening
lcsh:Science
Community Health Workers
Psychiatry
Multidisciplinary
Health services research
Social Discrimination
Community Mental Health Services
Mental Health
Neurology
Community health
Medicine
Public Health
Research Article
medicine.medical_specialty
India
Developing country
Nepal
Nursing
medicine
Humans
Tuberculosis
Developing Countries
Poverty
Primary Care
Epilepsy
Health Care Policy
Primary Health Care
business.industry
Public health
lcsh:R
HIV
Mental health
Social Epidemiology
Cross-Sectional Studies
Therapies
lcsh:Q
Ethiopia
business
Program Evaluation
Situation analysis
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 9
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....8d08730cc13ae9647e99354161118bed