Implementing mhGAP training to strengthen existing services for an internally displaced population in Pakistan

Abstract

Background.In 2014, over a million people were internally displaced after the launch of a military operation in North Waziristan, a tribal region on Pakistan's side of the Durand Line. Despite security concerns and restrictions, a collaborative mental health and psychosocial support initiative was undertaken in the district of Bannu. Monthly mental health camps were conducted for a period of 6 months by a multidisciplinary mental health team. The initiative also helped to assess mental health needs and plan training for primary care staff to strengthen existing resources.Methods.As part of this initiative, Mental Health Gap Action Programme (mhGAP) training was conducted for physicians and psychosocial staff in the affected district. This marked the first instance of implementing these guidelines in Pakistan following a humanitarian crisis. This paper describes the training process including the adaptation of the mhGAP curriculum, training of trainers, training workshops for primary care staff and an analysis of results of pre- and post-testing of their knowledge about common mental disorders using a 25-item questionnaire.Results.The gaps in knowledge of primary care physicians in recognizing and managing common mental disorders were clearly identified. The mean pre- and post-test scores of the participants were 15.43, 62% (p value 0.000, s.d. 4.05) and 19.48, 78% (p value 0.000, s.d. 3.13) respectively, which showed significant improvement.Conclusions.Despite the challenges of a humanitarian crisis, mhGAP guidelines can be successfully implemented to train primary care physicians in in low- and middle-income countries such as Pakistan. However, the dearth of primary care resources can hinder the complete integration of mental health services into primary healthcare.

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

“…The adapted version consisted of 6 true/false and 9 multiple choice questions. The pre-and post-knowledge questionnaire has been used to evaluate a number of mhGAP interventions [24][25][26][27][28].…”

Challenges and lessons learned in re-filming the WHO mhGAP training videos for Sri Lankan context - a qualitative study

“…As noted above, while the mhGAP package does include a set of freely available training videos, participants in the Siriwardhana et al study concluded that provision of videos in the local Tamil language would be more appropriate and effective. Other researchers have also found that videos included in the mhGAP package were not necessarily suitable due to issues of language and culture, and instead role-play was prioritised to enhance the learning process [14].…”

Developing competencies for the WHO mhGAP Intervention Guide Version 2.0 training package

“…Training in the first version of mhGAP-IG demonstrated improvements in pre-and post-training knowledge testing, but with the need for ongoing supervision 3,4 . Feedback collected by the WHO requested more experiential learning; a focus on building skills; easier access to training materials; shorter training of six days maximum with post-training supervision, and the addition of clinician competencies.…”

“…These lack the formality and resource-intensiveness of observed structured clinical examinations, which have high reliability and validity in clinical skill assessment 8 , but share similarities, such as instructions on discrete clinical scenarios, timing, checklists for candidate demonstration, and capacity for multiple role-plays to improve reliability and cover various skills. Role-plays also have the advantage of established acceptability in LMIC training settings 3,4 , and can utilize peer assessment to manage limited assessor availability 8 .…”