Study Shows Integrated Mental Healthcare Approach Can Help
The Programme for Improving Mental Healthcare (PRIME) in Nepal has responded to the need for more evidence on the feasibility and impact of integrating mental healthcare into primary care in low-income countries. The World Health Organization’s (WHO) flagship Mental Health Gap Action Programme (mhGAP) provides tools for the scale up of mental healthcare in low- and middle-income settings, but few formal evaluations have been published in scientific journals. The PRIME Nepal team is the first country to publish its major outcome findings.
The paper, published in PLOS Medicine on 14 February 2019, shares the primary findings from a collection of study designs. Together these findings indicate promise for the use of a district-level mental healthcare plan in low-resource community settings and primary care. The study has indicated an increase in the number of people seeking mental healthcare services (ranging from a 7.5% increase for alcohol-use disorder (AUD) to 50.2% for psychoses) as well as an improvement in the detection of mental illness by trained health workers. Once accessing health facilities with supervised mhGAP trained health workers, 3 out of 5 people with alcohol problems and 1 out of 4 with depression are detected when the knowledge and skills from training are still relatively fresh (6 months after training). The depression detection rate remained relatively stable after two years. The detection rate for AUD did, however decrease.
The study has further indicated that 95% of people that health workers correctly detected with depression or AUD received minimally adequate treatment 6 months post-training.
Finally, the study demonstrates that combination of interventions provided through the mental healthcare plan—which includes psychological treatments, psychotropic treatment and community counseling, all provided by non-specialists— results in beneficial effects for people living with depression, AUD, and psychosis. These benefits are improved daily functioning and a reduction in symptoms.
The PRIME Nepal team is led by Dr. Mark Jordans from the Centre for Global Mental Health at King’s College London and Nagendra Luitel from the Transcultural Psychosocial Organization Nepal (TPO). PRIME Nepal has also developed a community informant detection tool. This tool enables community workers and those actively involved in their communities to detect those living with mental illness and to assist in referring them for official diagnosis and treatment.
“This study has shown that having health workers who are not specialists deliver community- and primary-healthcare-based mental health services is a promising strategy to increase the number of people with mental health problems benefiting from such care. The study is unique in that it evaluates all steps in the service provision pathway, and at a population level.” says Dr. Jordans.