The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries: systematic review

Cubillos, Leonardo; Bartels, Sophia M.; Torrey, William C.; Naslund, John A.; Uribe-Restrepo, José Miguel; Gaviola, Chelsea; Díaz, Sergio Castro; John, Deepak; Williams, Makeda; Cepeda, M. Soledad; Gómez‐Restrepo, Carlos; Marsch, Lisa A.

doi:10.1192/bjb.2020.35

Cited by 37 publications

(40 citation statements)

References 66 publications

(135 reference statements)

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“…Although not a primary focus, this review also highlighted the dearth of cost effectiveness evidence for psychosocial treatments delivered by NSHW [ 12 ]. Cubillos et al (2020) [ 64 ] noted that investments in programs for integrating behavioural health services into primary care using task-sharing and collaborative/stepped care approaches yielded cost-effective estimates in LMIC settings. The latter review also noted that cost savings were reported when a societal perspective was used in economic evaluations, pointing to the importance of inclusion of broader costs in these economic evaluations.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluations of psychological treatments for common mental disorders in low- and middle-income countries: protocol for a systematic review

Mutyambizi-Mafunda

Myers

Sorsdahl

et al. 2021

Global Health Action

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Background Common mental disorders (CMDs) are highly prevalent conditions that constitute a major public health and economic burden on society in low- and middle-income countries (LMICs). Despite the increased demand for economic evidence to support resource allocation for scaled-up implementation of mental health services in these contexts, economic evaluations of psychological treatments for CMDs remain scarce. Objective The proposed systematic review aims to synthesize findings on methods and outcomes of economic evaluations of psychological treatments for CMDs in LMICs and appraise quality. Methods We will identify, select, and extract data from published economic evaluations of psychological interventions for CMDs conducted in LMICs. We will search bibliographic databases (PubMed, EMBASE, CINAHL, Web of Science, EconLit, PsycINFO, Africa-Wide Information, Cochrane library, Centre for Reviews and Dissemination (CRD), Cost Effectiveness Analysis (CEA) Registry), and the African Journals Online (AJOL) and Google Scholar platforms. Only full economic evaluations (Cost-Effectiveness Analysis (CEA), Cost-Utility Analysis (CUA), Cost-Consequence Analysis (CCA), or Cost-Benefit Analysis (CBA)) of psychological treatments for CMDs (defined as depressive, anxiety, and substance use disorders) conducted in LMICs will be included. There will be no restrictions based on date of publication, perspective, follow-up duration or sample size. Data extraction will be guided by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results The results presented will be examined using a narrative synthesis approach. The quality of included studies will be assessed using the Drummond & Jefferson checklist. Conclusion The fledgling evidence base in this area provides an opportunity to promote improved economic evaluation methods in line with repeated calls for economic evidence alongside effectiveness evidence in these settings. A rigorously developed economic evaluation evidence base will support resource allocation decisions for scaled up implementation of psychological interventions in LMIC settings. Systematic review registration PROSPERO CRD42020185277.

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Section: Discussionmentioning

confidence: 99%

Economic evaluations of psychological treatments for common mental disorders in low- and middle-income countries: protocol for a systematic review

Mutyambizi-Mafunda

Myers

Sorsdahl

et al. 2021

Global Health Action

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“…Integration of mental health services into mainstream services has been recommended globally [47], and this has been found to be both effective for intended treatment outcomes, as well as economically cost-effective [21,48]. While treatment effectiveness benefits the patients, cost-effectiveness has a direct benefit on the health system and an indirect benefit to the patients as the quality of treatment can be improved as more resources are available.…”

Section: Integrating Mental Health Into Mainstream Primary Health Car...mentioning

confidence: 99%

The Need to Strengthen Primary Health Care Services to Improve Mental Health Care Services in South Africa

Mokwena¹,

Mokwena²

2022

Primary Health Care

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Despite the reported increase in the prevalence of mental disorders, including substance abuse disorders, required services in South Africa have not been improved to meet the demands for these challenges. Although South Africa has invested in a process to conduct a re-engineering of primary health care services to address a range of common health challenges in communities, this process has not demonstrated adequate policy and practice changes toaddress emerging challenges in providing services for mental health disorders at primary health care level. In particular, primary health care services do not include routine screening for common mental disorders, which include depression, anxiety, postnatal depression and substance abuse, although there are easy to use tools for such screening. This has resulted in a failure for early detection of these mental health challenges by the health system. The chapter argues that making moderate changes to the current offerings of primary health care can result in major achievements in offering mental health services, which in turn will benefit the patients and assist health services to address the increasing scourge of mental disorders, which include substance abuse.

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“…Cubillos presented a preliminary review of 58 articles representing studies evaluating integrated mental health care in primary care settings in LMICs, with evidence to suggest that integration of mental health services improves outcomes for depression and alcohol use and is cost effective. Based on the review, Cubillos outlined a new typology of models of behavioral health integration that have been used in LMICs, including mental health care delivery by skilled and nonskilled mental health and primary care staff [ 61 ].…”

Section: Integrating Technology Into Practicementioning

confidence: 99%

Workshop on Implementation Science and Digital Therapeutics for Behavioral Health

Lord¹,

Campbell²,

Brunette³

et al. 2021

JMIR Ment Health

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Digital therapeutics can overcome many of the barriers to translation of evidence-based treatment for substance use, mental health, and other behavioral health conditions. Delivered via nearly ubiquitous platforms such as the web, smartphone applications, text messaging, and videoconferencing, digital therapeutics can transcend the time and geographic boundaries of traditional clinical settings so that individuals can access care when and where they need it. There is strong empirical support for digital therapeutic approaches for behavioral health, yet implementation science with regard to scaling use of digital therapeutics for behavioral health is still in its early stages. In this paper, we summarize the proceedings of a day-long workshop, “Implementation Science and Digital Therapeutics,” sponsored and hosted by the Center for Technology and Behavioral Health at Dartmouth College. The Center for Technology and Behavioral Health is an interdisciplinary P30 Center of Excellence funded by the National Institute on Drug Abuse, with the mission of promoting state-of-the-technology and state-of-the-science for the development, evaluation, and sustainable implementation of digital therapeutic approaches for substance use and related conditions. Workshop presentations were grounded in current models of implementation science. Directions and opportunities for collaborative implementation science research to promote broad adoption of digital therapeutics for behavioral health are offered.

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The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries: systematic review

Cited by 37 publications

References 66 publications

Economic evaluations of psychological treatments for common mental disorders in low- and middle-income countries: protocol for a systematic review

Economic evaluations of psychological treatments for common mental disorders in low- and middle-income countries: protocol for a systematic review

The Need to Strengthen Primary Health Care Services to Improve Mental Health Care Services in South Africa

Workshop on Implementation Science and Digital Therapeutics for Behavioral Health

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