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Development and piloting of a plan for integrating mental health in primary care in Sehore district, Madhya Pradesh, India

Published online by Cambridge University Press:  02 January 2018

Rahul Shidhaye ,
Sanjay Shrivastava ,
Vaibhav Murhar ,
Sandesh Samudre ,
Shalini Ahuja ,
Rohit Ramaswamy  and
Vikram Patel
Rahul Shidhaye*
Affiliation:
Public Health Foundation of India, Bhopal, Madhya Pradesh, India, and CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
Sanjay Shrivastava
Affiliation:
PRIME project (India), Sangath, India
Vaibhav Murhar
Affiliation:
PRIME project (India), Sangath, India
Sandesh Samudre
Affiliation:
Public Health Foundation of India
Shalini Ahuja
Affiliation:
Public Health Foundation of India
Rohit Ramaswamy
Affiliation:
Public Health Leadership and Maternal and Child Health, University of North Carolina, Chapel Hill, North Carolina, USA and Adjunct Faculty, Public Health Foundation of India
Vikram Patel
Affiliation:
London School of Hygiene & Tropical Medicine, London, UK, Public Health Foundation of India and Sangath, India
*
Rahul Shidhaye, Public Health Foundation of India, 19, Rishi Nagar, Char Imli, Bhopal, Madhya Pradesh, India. Email: rahul.shidhaye@phfi.org
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Abstract

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Background

The large treatment gap for mental disorders in India underlines the need for integration of mental health in primary care.

Aims

To operationalise the delivery of the World Health Organization Mental Health Gap Action Plan interventions for priority mental disorders and to design an integrated mental healthcare plan (MHCP) comprising packages of care for primary healthcare in one district.

Method

Mixed methods were used including theory of change workshops, qualitative research to develop the MHCP and piloting of specific packages of care in a single facility.

Results

The MHCP comprises three enabling packages: programme management, capacity building and community mobilisation; and four service delivery packages: awareness for mental disorders, identification, treatment and recovery. Challenges were encountered in training primary care workers to improve identification and treatment.

Conclusions

There are a number of challenges to integrating mental health into primary care, which can be addressed through the injection of new resources and collaborative care models.

Type
Papers
Information
The British Journal of Psychiatry , Volume 208 , Issue s56: Mental health plans in five low- and middle-income countries: PRogramme for Improving Mental health carE (PRIME) , January 2016 , pp. s13 - s20
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Copyright
Copyright © Royal College of Psychiatrists, 2016

Footnotes

This study is an output of the PRogramme for Improving Mental health carE (PRIME). This research has been funded by UK aid from the UK government. However, the views expressed do not necessarily reflect the UK government's official policies. V.P. is supported by a Wellcome Trust senior clinical fellowship.

Declaration of interest

None.

References

1 Institute for HealthMetrics and Evaluation (IHME). India: Global Burden of Disease Study. IHME, 2010 (http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_india.pdf/).Google Scholar
2 Patel, V, Araya, R, Chatterjee, S, Chisholm, D, Cohen, A, De Silva, M, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet 2007; 370: 991–1005.CrossRefGoogle ScholarPubMed
3 Murthy, RS. Mental health initiatives in India (1947-2010). Natl Med J India 2011; 24: 98–107.Google ScholarPubMed
4 Goel, DS. Why mental health services in low- and middle-income countries are underresourced, under-performing: an Indian perspective. Natl Med J India 2011; 24: 94–7.Google Scholar
5 Ministry of Health & Family Welfare (MOHFW). The Mental Health Care Bill. MOHFW, 2013 (http://www.prsindia.org/billtrack/the-mental-healthcare-bill-2013-2864).Google Scholar
6 Ministry of Health & Family Welfare (MOHFW). XIIth Plan District Mental Health Programme. MOHFW, 2012 (https://mhpolicy.files.wordpress.com/2012/07/final-dmhp-design-xii-plan2.pdf).Google Scholar
7 Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 2012; 9: e1001359.CrossRefGoogle Scholar
8 Craig, P, Dieppe, P, Macintyre, S, Michie, S, Nazareth, I, Petticrew, M, et al. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008; 337: a1655.CrossRefGoogle ScholarPubMed
9 De Silva, MJ, Rathod, SD, Hanlon, C, Breuer, E, Chisholm, D, Fekadu, A, et al. Evaluation of district mental healthcare plans: the PRIME consortium methodology. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153858).CrossRefGoogle Scholar
10 Rahman, A, Surkan, PJ, Cayetano, CE, Rwagatare, P, Dickson, KE. Grand challenges: integrating maternal mental health into maternal and child health programmes. PLoS Med 2013; 10: e1001442.CrossRefGoogle ScholarPubMed
11 Hanlon, C, Luitel, NP, Kathree, T, Murhar, V, Shrivasta, S, Medhin, G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries. PLoS One 2014; 9: e88437.CrossRefGoogle ScholarPubMed
12 Vogel, I. Review of the Use of ‘Theory of Change’. Department for International Development (DFID), 2012.Google Scholar
13 Breuer, E, De Silva, MJ, Shidaye, R, Petersen, I, Nakku, J, Jordans, MJD, et al. Planning and evaluating mental health services in low- and middle-income countries using theory of change. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153841).CrossRefGoogle Scholar
14 World Health Organization. Mental Health Gap Action Programme (mhGAP): Scaling Up Care for Mental, Neurological and Substance Abuse Disorders. WHO, 2008.Google Scholar
15 Bower, P, Gilbody, S. Managing common mental health disorders in primary care: conceptual models and evidence base. BMJ 2005; 330: 839–42.CrossRefGoogle ScholarPubMed
16 Jenkins, R, Othieno, C, Okeyo, S, Kaseje, D, Aruwa, J, Oyugi, H, et al. Short structured general mental health in service training programme in Kenya improves patient health and social outcomes but not detection of mental health problems - a pragmatic cluster randomised controlled trial. Int J Ment Health Syst 2013; 7: 25.CrossRefGoogle Scholar
17 Goncalves, DA, Fortes, S, Campos, M, Ballester, D, Portugal, FB, Tófoli, LF, et al. Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study. Gen Hosp Psychiatry 2013; 35: 304–8.CrossRefGoogle Scholar
18 Patel, V, Weiss, HA, Chowdhary, N, Naik, S, Pednekar, S, Chatterjee, S, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet 2010; 376: 2086–95.CrossRefGoogle Scholar
19 De Savigny, D, Adam, T. Systems Thinking for Health Systems Strengthening. Alliance for Health Policy and Systems Research. WHO, 2009.Google Scholar
20 Thornicroft, G, Tansella, M. Are community mental health services relevant in low- and middle-income countries? Epidemiol Psychiatr Sci 2014; 23: 115–8.CrossRefGoogle ScholarPubMed
21 Thara, R, John, S, Chatterjee, S. Community mental health teams in low- and middle-income countries. Epidemiol Psychiatr Sci 2014; 23: 119–22.CrossRefGoogle ScholarPubMed
22 Kigozi, F, Ssebunnya, J. The multiplier role of psychiatrists in low income settings. Epidemiol Psychiatr Sci 2014; 23: 123–7.CrossRefGoogle ScholarPubMed
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