Situational analysis to inform development of primary care and community-based mental health services for severe mental disorders in Nepal

Angdembe, Mangesh; Kohrt, Brandon A.; Jordans, Mark J. D.; Rimal, Damodar; Luitel, Nagendra P.

doi:10.1186/s13033-017-0176-9

Cited by 27 publications

(40 citation statements)

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“…In our case, this concept translates into non-specialists’ belief in their capability to successfully detect, treat, and manage mental health issues at the level of primary care [ 39 ]. Studies show that non-specialists question their involvement in the field of mental health because they are not confident in their general mental health skills [ 12 , 40 , 41 ]. Lower levels of confidence in mental health skills is reportedly one of the main factors influencing non-specialists’ decisions to refer patients to specialized mental health services [ 42 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Spagnolo¹,

Champagne²,

Leduc³

et al. 2018

Int J Ment Health Syst

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BackgroundNon-specialists’ involvement in mental health care is encouraged in the field of global mental health to address the treatment gap caused by mental illness, especially in low- and middle-income countries. While primary care physicians (PCPs) are involved in mental health care in Tunisia, a lower-middle-income country in North Africa, it is unclear to what extent they are prepared and willing to address mental health problems, substance use disorders, and suicide/self-harm. In this context, we aim (1) to report on mental health knowledge, attitudes, and self-efficacy among a sample of PCPs working in the Greater Tunis area, prior to the implementation of a mental health training program developed by the World Health Organization; and (2) to identify what characteristics are associated with these competencies.MethodsIn total, 112 PCPs completed questionnaires related to their socio-demographic and practice characteristics, as well as their mental health knowledge, attitudes, and self-efficacy. Descriptive analyses and regression models were performed.FindingsPCPs had more knowledge about depression, symptoms related to psychosis, and best practices after a suicide attempt; had favourable attitudes about distinctions between physical and mental health, learning about mental health, and the acceptance of colleagues with mental health issues; and believed most in their capabilities related to depression and anxiety. However, most PCPs had less knowledge about substance use disorders and myths about suicide attempts; had unfavorable attitudes about the dangerousness of people with mental health problems, personal disclosure of mental illness, non-specialists’ role in assessing mental health problems, and personal recovery; and believed the least in their capabilities related to substance use disorders, suicide/self-harm, and psychosis. Participation in previous mental health training, weekly hours (and weekly hours dedicated to mental health), weekly provision of psychoeducation, and certain work locations were associated with better mental health competencies, whereas mental health knowledge was negatively associated with weekly referrals to specialized services.ConclusionsFindings suggest that PCPs in our sample engage in mental health care, but with some gaps in competencies. Mental health training and increased interactions/involvement with people consulting for mental health issues may help further develop non-specialists’ mental health competencies, and integrate mental health into primary care settings.Electronic supplementary materialThe online version of this article (10.1186/s13033-018-0243-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Spagnolo¹,

Champagne²,

Leduc³

et al. 2018

Int J Ment Health Syst

View full text Add to dashboard Cite

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“…For this analysis, studies are counted as ‘single country’ if they reported results from only one country in a paper, regardless of their broader affiliation with multi-country research programs. Of the studies, 14 (58.3%) took place in multiple countries, with high representation in this review of papers published by consortia such as the Programme to Improve Mental Health Care (PRIME) (Jordans et al ., 2013 ; Hanlon et al ., 2014 ; Asher et al ., 2015 ; Luitel et al ., 2015 ; Shidhaye et al ., 2015 ; Baron et al ., 2016 ; Hailemariam et al ., 2016 ; Kigozi et al ., 2016 ; Angdembe et al ., 2017 ) and the Emerging Mental Health Systems in LMICs (EMERALD) study (Abdulmalik et al ., 2016 ; Upadhaya et al ., 2016 ; Mugisha et al ., 2017 ). Ten (41.6%) focused on a single country.…”

Section: Resultsmentioning

confidence: 99%

“…Studies also used qualitative methods to understand acceptability, including the acceptability of integrating mental health care into existing services (e.g. primary care, HIV service delivery, community-based care) (Jordans et al ., 2013 ; Dos Santos & Wolvaardt, 2016 ; Petersen et al ., 2016 ; Angdembe et al ., 2017 ), the acceptability of treatment options and interventions (Asher et al ., 2015 ; Yu et al ., 2017 ) and gaps in human resources for mental health (Sikwese et al ., 2010 ).…”

Section: Resultsmentioning

confidence: 99%

“…Five other studies implicitly addressed issues related to equity but did not incorporate it in their study design; that was addressed by discussing the impact of poverty on help-seeking (Angdembe et al ., 2017 ), the relationship between poverty and mental health and gaps in social protection for people with mental illness (Ofori-Atta et al ., 2010 ), the implications of community mobilization for social inclusion, reduced stigma and improving economic status (Asher et al ., 2015 ), the impact of poverty and living circumstances on women's mental health (Davies et al ., 2016 ) and the role of mental health information systems in capturing equity in service distribution for women, people with low socioeconomic status, and rural inhabitants (Shidhaye et al ., 2015 ).…”

Section: Resultsmentioning

confidence: 99%

“…The most commonly cited limitation of qualitative studies was the limited scope of the study area and of study participants, which could limit generalizability of findings (Jordans et al ., 2013 ; De Kock & Pillay, 2016 ; Angdembe et al ., 2017 ; Yu et al ., 2017 ). Other limitations included language barriers between researchers and study participants, requiring the translation of interview transcripts and the risk of loss of meaning or misunderstanding of findings (Angdembe et al ., 2017 ; Olofsson et al ., 2018 ).…”

Section: Resultsmentioning

confidence: 99%

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Methodological approaches to situational analysis in global mental health: a scoping review

et al. 2019

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Global inequity in access to and availability of essential mental health services is well recognized. The mental health treatment gap is approximately 50% in all countries, with up to 90% of people in the lowest-income countries lacking access to required mental health services. Increased investment in global mental health (GMH) has increased innovation in mental health service delivery in LMICs. Situational analyses in areas where mental health services and systems are poorly developed and resourced are essential when planning for research and implementation, however, little guidance is available to inform methodological approaches to conducting these types of studies. This scoping review provides an analysis of methodological approaches to situational analysis in GMH, including an assessment of the extent to which situational analyses include equity in study designs. It is intended as a resource that identifies current gaps and areas for future development in GMH. Formative research, including situational analysis, is an essential first step in conducting robust implementation research, an essential area of study in GMH that will help to promote improved availability of, access to and reach of mental health services for people living with mental illness in low- and middle-income countries (LMICs). While strong leadership in this field exists, there remain significant opportunities for enhanced research representing different LMICs and regions.

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Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

et al. 2021

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IMPORTANCE Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care. OBJECTIVE To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs). DESIGN, SETTING, AND PARTICIPANTSThis pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021. INTERVENTIONS In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives. MAIN OUTCOMES AND MEASURES Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining. RESULTS Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirtyfour facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were −10.6 points (95% CI, −14.5 to −6.74 points) in RESHAPE and −2.79 points (−8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events.(continued) Key Points Question Does involvement of people with lived experience of mental illness in cofacilitation of trainings for primary care practitioners reduce stigma and improve mental health services? Findings In this pilot cluster r...

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Situational analysis to inform development of primary care and community-based mental health services for severe mental disorders in Nepal

Cited by 27 publications

References 50 publications

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Mental health knowledge, attitudes, and self-efficacy among primary care physicians working in the Greater Tunis area of Tunisia

Methodological approaches to situational analysis in global mental health: a scoping review

Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

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