Australian experts' perspectives on a curriculum for psychologists working in primary health care: implication for Indonesia

Setiyawati, Diana; Blashki, Grant; Wraith, Ruth; Colucci, Erminia; Minas, Harry

doi:10.1080/21642850.2014.951937

Cited by 6 publications

(6 citation statements)

References 24 publications

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“…There is good evidence for the effectiveness of psychotherapy delivered in primary care (Hass et al, 2004) and that psychotherapy is as effective as antidepressant medication . The co-location of clinical psychologists in primary care improves collaboration and potentially reduce the stigma of mental illness and barriers to care (Derksen, 2009, Elder and Silvers, 2009, Setiyawati et al, 2014.…”

Section: Interventionsmentioning

confidence: 99%

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Evaluating the Clinical Cost-effectiveness of Two Primary Mental Health Service Frameworks in Yogyakarta, Indonesia v1

Anjara¹,

Bonetto²,

Brayne³

et al. 2019

Preprint

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Ba ckground Ba ckground The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Despite its importance, mental health provisions are often limited. In 2015, Indonesia had only 773 psychiatrists for 250 million residents. This shortage of specialist mental health professionals is shared by most Low-and Middle-Income Countries (LMICs) and is reflected in the Treatment Gaps in this region indicating the very small proportion of people who receive adequate mental health care for their needs. While the median worldwide Treatment Gap for psychosis is 32.2% (Kohn et al., 2004), in Indonesia it is more than 90%. Experts suggested integrating mental health care into primary care, to help bridge this gap (Mendenhall et al., 2014). The systematic introduction of the World Health Organization Mental Health Gap Action Programme into primary care clinics across Indonesia and the presence of a 15-year-old colocation of Clinical Psychologists in Yogyakarta province's primary care clinics presented an opportunity to assess the clinical and cost-effectiveness of both frameworks. Me thods Me thods This research ("the trial") set out to develop an approach, and then implement it, to compare the adapted WHO mhGAP framework with the existing specialist framework within primary mental health services in Yogyakarta, Indonesia, through a pragmatic, two-arm cluster randomised controlled non-inferiority trial. This design enabled an examination of patients derived from whole populations in a 'real world' setting. The trial involved two phases: a pilot study in June 2016 with the objectives to refine data collection procedures and to serve as a practice run for clinicians involved in the trial; as well as a substantive trial beginning in December 2016. The 12-item General Health Questionnaire (GHQ-12) was established as a 'fairly accurate' screening tool using a Receiver Operating Curve study. Using the GHQ scoring method of 0-0-1-1, a threshold of 1/2 was identified for use in clinical setting, i.e. the context of the trial. The primary outcome was the health and social functioning of participants as measured by the Health of the Nation Outcome Scale (HoNOS) and secondary outcomes were disability as measured by WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), quality of life as measured by European Quality of Life Scale (EQ-5D-3L), and cost of intervention evaluated from a health services perspective, which aimed to determine the clinical effectiveness and cost-effectiveness of both frameworks at six months. Re sul ts Re sul ts During the recruitment period, 4944 adult primary care patients attended 27 participating primary care centres. Following screening (n=1484) and in-depth psychiatric interviews (n=394), 174 WHO mhGAP arm and 151 Specialist arm participants received a formal diagnosis and were recruited into the trial. The number of required participants per treatment arm, to provide statistical power of 0.80 and statisti...

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Section: Interventionsmentioning

confidence: 99%

“…Greeting older and important stakeholders, SGA bowed and touched her forehead to the back of their right hand. Towards research assistants, SGA had to balance authority with Javanese politeness, aware of the secondary status of a woman in Javanese culture (Smith-Hefner, 1988).…”

Section: Cultural Challengesmentioning

confidence: 99%

Evaluating the Clinical Cost-effectiveness of Two Primary Mental Health Service Frameworks in Yogyakarta, Indonesia v1

Anjara¹,

Bonetto²,

Brayne³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…There is good evidence for the effectiveness of psychotherapy delivered in primary care [23] and that psychotherapy is as effective as antidepressant medication [24]. The co-location of Clinical Psychologists in primary care improves collaboration and potentially reduce the stigma of mental illness and barriers to care [25–27].…”

Section: Introductionmentioning

confidence: 99%

Can General Practitioners manage mental disorders in primary care? A partially randomised, pragmatic, cluster trial

et al. 2019

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BackgroundFor a decade, experts have suggested integrating mental health care into primary care to help bridge mental health Treatment Gap. General Practitioners (GPs) are the first port-of-call for many patients with mental ill-health. In Indonesia, the WHO mhGAP is being systematically introduced to its network of 10,000 primary care clinics as an add-on mental health training for pairs of GPs and Nurses, since the end of 2015. In one of 34 provinces, there exists an integrated care model: the co-location of clinical psychologists in primary care clinics. This trial evaluates patient outcomes among those provided mental health care by GPs with those treated by clinical psychologists in primary care.MethodsIn this partially-randomised, pragmatic, two-arm cluster non-inferiority trial, 14 primary care clinics were assigned to receive the WHO mhGAP training and 14 clinics with the co-location framework were assigned to the Specialist arm. Participants (patients) were blinded to the existence of the other pathway, and outcome assessors were blinded to group assignment.All adult primary care patients who screened positive for psychiatric morbidity were eligible. GPs offered psychosocial and/or pharmacological interventions and Clinical Psychologists offered psychosocial interventions. The primary outcome was health and social functioning as measured by the HoNOS and secondary outcomes include disability measured by WHODAS 2.0, health-related quality of life measured by EQ‐5D-3L, and resource use and costs evaluated from a health services perspective, at six months.Results153 patients completed the outcome assessment following GP care alongside 141 patients following Clinical Psychologists care. Outcomes of GP care were proven to be statistically not inferior to Clinical Psychologists in reducing symptoms of social and physical impairment, reducing disability, and improving health-related quality of life at six months. Economic analyses indicate lower costs and better outcomes in the Specialist arm and suggest a 50% probability of WHO mhGAP framework being cost-effective at the Indonesian willingness to pay threshold per QALY.ConclusionGeneral Practitioners supported by nurses in primary care clinics could effectively manage mild to moderate mental health issues commonly found among primary care patients. They provide non-stigmatising mental health care within community context, helping to reduce the mental health Treatment Gap.Trial registrationClinicalTrials.gov NCT02700490

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“…The objective of this study is to reach a consensus among experts from around the world based on their own experiences and perspectives about the key roles and training required for psychologists who will be working in primary health care. This consensus will inform the development of a curriculum for psychologists working in primary health care in Indonesia, and is part of a broader suite of studies (Setiyawati, Blashki, Wraith, Colucci, & Minas, 2013a , Setiyawati, Blashki, Wraith, Colucci, & Minas, 2013b , Setiyawati, Blashki, Wraith, Colucci, & Minas, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

International experts’ perspectives on a curriculum for psychologists working in primary health care: implication for Indonesia

Setiyawati

Colucci

Blashki

et al. 2014

Health Psychology and Behavioral Medicine

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Enhancing primary health care to incorporate mental health services is a key strategy for closing the treatment gap for people with mental disorders. The integration of psychological care into primary health care is a critical step in addressing poor access to mental health specialists. As the psychology profession is increasingly called upon to prepare psychologists for primary health care settings, an international experts' consensus is valuable in guiding the development of a high-quality curriculum for psychologists working in the primary health care context. A Delphi method was used to gain a consensus on the most appropriate roles and training for psychologists. Initial constructs and themes were derived from a detailed literature review and sent to 114 international experts in primary mental health care from five continents. Overall, 52 experts who participated agreed that psychologists should have wide-ranging roles and skills including clinical, health promotion and advocacy skills. This study has identified the specific roles and training needed by psychologists to enable them to work more effectively in primary health care settings. The consensus will inform the development of a curriculum for psychologists working in primary health care in Indonesia, and is part of a broader suite of studies.

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Australian experts' perspectives on a curriculum for psychologists working in primary health care: implication for Indonesia

Cited by 6 publications

References 24 publications

Evaluating the Clinical Cost-effectiveness of Two Primary Mental Health Service Frameworks in Yogyakarta, Indonesia v1

Evaluating the Clinical Cost-effectiveness of Two Primary Mental Health Service Frameworks in Yogyakarta, Indonesia v1

Can General Practitioners manage mental disorders in primary care? A partially randomised, pragmatic, cluster trial

International experts’ perspectives on a curriculum for psychologists working in primary health care: implication for Indonesia

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