Back to Search Start Over

Challenges and Opportunities for Implementing Integrated Mental Health Care: A District Level Situation Analysis from Five Low- and Middle-Income Countries

Authors :
Vikram Patel
Nagendra P. Luitel
Rahul Shidhaye
Sanjay Shrivasta
Mark J. D. Jordans
Mark Tomlinson
Tasneem Kathree
Fred Kigozi
Graham Thornicroft
Girmay Medhin
Vaibhav Murhar
Erica Breuer
Inge Petersen
Abebaw Fekadu
Crick Lund
Charlotte Hanlon
Mary De Silva
Martin Prince
Joshua Ssebunnya
Centre for Public Mental Health
Faculty of Health Sciences
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.

Details

ISSN :
19326203
Volume :
9
Database :
OpenAIRE
Journal :
PLoS ONE
Accession number :
edsair.doi.dedup.....8d08730cc13ae9647e99354161118bed