Implementing an mhGAP-based training and supervision package to improve healthcare workers’ competencies and access to mental health care in Malawi

Ahrens, Jen; Kokota, Demoubly; Mafuta, Chitsanzo; Konyani, Mary; Chasweka, Dennis; Mwale, Owen; Stewart, Robert C.; Osborn, Madeline; Chikasema, Blessings; Mcheka, Mondie; Blackwood, Douglas; Gilfillan, Sheila

doi:10.1186/s13033-020-00345-y

Cited by 16 publications

(20 citation statements)

References 29 publications

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“…Similar results were indicated by previous reports that examined changes in knowledge and attitude of primary healthcare workers and primary care physicians after short-term trainings [ 10 , 12 – 14 ].…”

Section: Discussionsupporting

confidence: 91%

Impact of intensive training on mental health, the experience of Port Said, Egypt

Bellizzi¹,

Khalil

Sawahel

et al. 2021

Int J Ment Health Syst

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Background Mental disorder is extremely common globally and integration of mental health in primary health services represents a critical gap especially in low- and middle-income Countries like Egypt. The World Health Organization has repeatedly called for effective training and support of primary care providers in the identification and treatment of mental health problems over the last decades. Methods This paper aimed to evaluate attitudes and knowledge of health care providers toward mentally ill patients and measure knowledge and retention of training messages over time. A 3-day mental health training workshop for nurses of public health facilities in the Governorate of Port Said was organized. Pre-training and post-training questionnaires (immediately after the workshop and 3 months later) were used. Significance of gain in scores was examined between baseline and following cross sectional rounds. Results The 73 participants in the study revealed a statistically significant improvement in knowledge and attitude toward mental health from the baseline (pre-training), from a general mean score for desirable answers of 10.5 (± 1.2) to 21.2 (± 0.6). However, results slightly declined three months after from the workshop (18.5 (± 0.6)). Conclusions Intensive short-term training on mental illness could be instrumental in improving knowledge and attitudes in countries like Egypt with extensive needs in terms of quality of comprehensive healthcare at primary and secondary level. However, additional evidence is needed to improve retention of information over time and to translate knowledge into clinical practice.

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Section: Discussionsupporting

confidence: 91%

Impact of intensive training on mental health, the experience of Port Said, Egypt

Bellizzi¹,

Khalil

Sawahel

et al. 2021

Int J Ment Health Syst

View full text Add to dashboard Cite

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“…In Malawi, scale up is further challenged by the way mental health treatment is managed in relation to levels of the country’s healthcare delivery system [ 6 ]. In some parts of the country, mental health care has been integrated into primary and secondary care [ 7 ], however most patients with mental health problems are only able to access care at just three central hospitals where services are focused on treating the most severe mental health disorders. Reserving mental health resources for the only most severely affected creates a gap in service across lower levels of the healthcare system, potentially leaving many individuals with less severe cases of depression undiagnosed and untreated.…”

Section: Introductionmentioning

confidence: 99%

Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers

Zimba¹,

Akiba

Matewere³

et al. 2021

Int J Ment Health Syst

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Background Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. Methods Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers. Results Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow. Conclusion Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge. Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT03711786

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“…Clinical o cers in Kenya working in primary care assess, diagnose and treat patients with psychosis and refer complex cases [24]. Malawian clinical o cers who have undergone further specialist training in psychiatry form part of District Mental Health Teams based at district hospitals [25]. According to Ethiopia's National Mental Health Strategy, health o cers have an important role to play in mental health service provision at health centres together with general practitioners and nurses [26].…”

Section: Discussionmentioning

confidence: 99%

Mental health task-sharing in South Africa – a role for clinical associates?

Moodley

Wolvaardt

Grobler

2022

Preprint

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BackgroundSouth Africa (SA) lacks the specialised workforce needed to provide mental health services particularly in the public sector and in rural areas. Mid-level medical workers offer a potential option for mental health task-sharing in countries where they exist including SA. The objectives of the study were to explore the roles that SA’s mid-level medical worker cadre (clinical associates) could play in mental health service delivery, and to explore views on advanced training in mental health for this cadre.MethodsThis was an explorative, qualitative study involving key informants linked to the three clinical associate training programmes in SA. A total of 19 in-depth interviews were conducted with university-based academic staff, facility-based trainers, and student representatives. The interviews were audio-recorded and professionally transcribed. Atlas.ti software was used to analyse the data and themes were identified.ResultsTwo themes were identified viz. ‘there is a place for them at the table’ and ‘earning a seat at the table’. Participants felt that there was a definite role for clinical associates in mental health service provision. The levels of care thought most appropriate were primary health care facilities and district hospitals. The most frequently identified role for clinical associates was in providing immediate care and stabilising mental health patients presenting in emergency settings. Other potential settings included inpatient wards, outpatients’ departments, and in communities (e.g. home visits). There was virtually unanimous support for additional training and in particular a postgraduate clinical specialisation in mental health . Participants felt a clinical specialisation in mental health would strengthen the health system by addressing workforce shortages as well as access and equity issues. They also held the view it would strengthen the profession by creating a career path and providing more employment opportunities for clinical associates.ConclusionsThere was broad support for a role for clinical associates in mental health service delivery in SA as well as for the establishing a clinical specialisation in mental health for clinical associates. Clinical associates with advanced training in mental health could potentially play an important role in rural settings to alleviate the shortage of specialist mental health practitioners.

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Implementing an mhGAP-based training and supervision package to improve healthcare workers’ competencies and access to mental health care in Malawi

Cited by 16 publications

References 29 publications

Impact of intensive training on mental health, the experience of Port Said, Egypt

Impact of intensive training on mental health, the experience of Port Said, Egypt

Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers

Mental health task-sharing in South Africa – a role for clinical associates?

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