Integrating mental health into primary care: Evaluating the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project

Abstract

Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria, using the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG) to treat common mental and neurological disorders in the primary care setting. This study evaluates the impact of the HAPPINESS pilot project training on trainees’ beliefs and attitudes about mental disorders and explores the perspectives of trainees, trainers, and health services officials on its implementation using a convergent, mixed-methods approach. Methods Trainees completed a 43-item questionnaire, before and after their 5-day training, to assess perceptions of mental disorders and attitudes towards people with mental illness. Paired-sample t-tests were conducted with respect to four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured Key Informant Interviews with trainees, trainers, and local health officials who participated in or supported the HAPPINESS Project were also analyzed. Findings from the questionnaire and interviews were merged using a convergent, mixed method approach. Results Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. The HAPPINESS Project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Lastly, respondents suggested ways that the HAPPINESS Project could be improved and expanded in the future. Conclusion This study adds to the limited existing evidence on the impact of mhGAP-IG-based training for primary care workers in Nigeria. Notably, it quantitatively evaluates pre and post training change in stigma level among trainees. Future efforts should focus on clinical support, supervision and implementation outcomes as well as scaling up and assessing the cost-effectiveness of the HAPPINESS Project intervention.