A program to further integrate mental health into primary care: lessons learned from a pilot trial in Tunisia

Abstract

Back Background ground Tunisia is a lower-middle-income country located in North Africa. Since the 2010-2011 Revolution, a campaign of civil resistance to protest high levels of youth unemployment, difficult living conditions, and government corruption, a rise in mental health problems, substance use disorders, and suicide attempts/deaths has been recorded. To address untreated mental health symptoms, a mental health training program was offered to primary care physicians (PCPs) working in the Greater Tunis area of Tunisia, a collaboration between members of the Tunisian Ministry of Health,

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

“…There are a range of activities and actions that LMICs might consider in the future to address existing barriers and challenges to the management of patients with BP-II. These include improving access to services and treatment including medicines, with potentially mobile clinics and improved training helping [11,228]. Addressing these challenges represents a unique opportunity to address the broader issue of increasing access to treatments and care for patients with mental disorders generally.…”

“…The global burden of these disorders has risen in recent years, especially among lower and middle-income countries (LMICs), as a result of demographic, environmental, unrest and socio-political changes [8][9][10]. For instance, there has been an appreciable increase in the burden of mental disorders in the Eastern Mediterranean Region in recent years with increasing levels of instability as well as stigma associated with mental health [10][11][12]. In Ethiopia, mental illness is now the leading non-communicable disease (NCD) in terms of its overall burden [13], and in Lebanon, approximately one-quarter of the population have had at least one mental disorder with 10.5% of the population experiencing more than one disorder at some stage [14].…”

“…There are only approximately 200 psychiatrists in Nigeria serving a population of 170 million, with only 10% of the population with common but serious mental disorders receiving minimally adequate treatment [25]. In Tunisia, there are currently only 3.7 mental health nurses per 100,000 of the population and 2.9 psychosocial care providers [26]; however, there are ongoing initiatives to improve mental health provision among nonspecialists including primary health-care physicians to help address current deficiencies in care provision [11]. Even in South Africa, only approximately 1 in 4 patients with mental disorders receive some form of treatment [27].…”

“…• There have been ongoing developments to improve the management of patients with mental health disorders in Tunisia in recent years following the publication of the Tunisian National Strategy for the Promotion of Mental Health in 2013 and the creation of the Committee for Mental Health Promotion in 2015 [11,182].…”

“…• More recently, there has been greater training of primary health-care physicians on mental health issues under the WHO mGAP project to address deficits in the provision of specialist services especially with 30-40% of consultations undertaken by primary health-care physicians relating to mental health care [11,26,183]. This should help with greater identification and management of patients with depression and symptoms related to psychosis.…”