89 research outputs found
WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: a systematic review of evidence from low and middle-income countries
Full text linkQUESTION: Despite mental, neurological and substance use (MNS) disorders being highly prevalent, there is a worldwide gap between service need and provision. WHO launched its Mental Health Gap Action Programme (mhGAP) in 2008, and the Intervention Guide (mhGAP-IG) in 2010. mhGAP-IG provides evidence-based guidance and tools for assessment and integrated management of priority MNS disorders in low and middle-income countries (LMICs), using clinical decision-making protocols. It targets a non-specialised primary healthcare audience, but has also been used by ministries, non-governmental organisations and academics, for mental health service scale-up in 90 countries. This review aimed to identify evidence to date for mhGAP-IG implementation in LMICs. STUDY SELECTION AND ANALYSIS: We searched MEDLINE, Embase, PsycINFO, Web of Knowledge/Web of Science, Scopus, CINAHL, LILACS, SciELO/Web of Science, Cochrane, Pubmed databases and Google Scholar for studies reporting evidence, experience or evaluation of mhGAP-IG in LMICs, in any language. Data were extracted from included papers, but heterogeneity prevented meta-analysis. FINDINGS: We conducted a systematic review of evidence to date, of mhGAP-IG implementation and evaluation in LMICs. Thirty-three included studies reported 15 training courses, 9 clinical implementations, 3 country contextualisations, 3 economic models, 2 uses as control interventions and 1 use to develop a rating scale. Our review identified the importance of detailed reports of contextual challenges in the field, alongside detailed protocols, qualitative studies and randomised controlled trials. CONCLUSIONS: The mhGAP-IG literature is substantial, relative to other published evaluations of clinical practice guidelines: an important contribution to a neglected field
Mental health service coverage and gaps among adults in Europe:a systematic review
Full text linkEnsuring the right to the highest attainable standard of mental healthcare requires a clear understanding of the current state of service coverage and gaps across Europe. Given the wide heterogeneity of health systems and resources, systematically assessing these gaps is crucial in order to identify inequities, inform policy and guide efforts to strengthen care at regional and national levels. In this Series paper, we systematically reviewed 45 studies reporting 198 national or sub-national estimates of adult mental health service coverage and treatment gaps in the World Health Organization (WHO) European Region. Data were scarce for many countries and conditions, heterogeneous in definitions, and rarely longitudinal, limiting comparability and trend analysis. Coverage for psychotic disorders was generally higher, often exceeding 90% in some countries but varied widely. For major depressive disorder, minimally adequate treatment ranged from below 10% in Bulgaria, Tajikistan and Turkmenistan to over 35% in Germany and Czechia. Anxiety disorder coverage ranged from 7% in Bulgaria to 47% in Sweden; most substance use disorder estimates were under 15%, and adult ADHD coverage was typically below 10%, based on outdated data. Trend analyses indicated minimal increases in depression coverage over two decades and mixed patterns for psychosis. Marginalised groups, including refugees, homeless populations and sexual minorities, faced the largest gaps, sometimes exceeding 80%. The lack of standardised, repeated measures hampers tracking of progress toward WHO's 2030 goal of a 50% increase in coverage. We advocate that harmonised monitoring systems, with attention to treatment adequacy and equity, are urgently needed to close persistent mental health care gaps across Europe
Global health partnership for student peer-to-peer psychiatry e-learning: Lessons learned
Full text linkBACKGROUND: Global 'twinning' relationships between healthcare organizations and institutions in low and high-resource settings have created growing opportunities for e-health partnerships which capitalize upon expanding information technology resources worldwide. E-learning approaches to medical education are increasingly popular but remain under-investigated, whilst a new emphasis on global health teaching has coincided with university budget cuts in many high income countries.RESULTS: King's Somaliland Partnership (KSP) is a paired institutional partnership health link, supported by Tropical Health and Education Trust (THET), which works to strengthen the healthcare system and improve access to care through mutual exchange of skills, knowledge and experience between Somaliland and King's Health Partners, UK. Aqoon, meaning knowledge in Somali, is a peer-to-peer global mental health e-learning partnership between medical students at King's College London (KCL) and Hargeisa and Amoud Universities, Somaliland. It aims to extend the benefits of KSP's cross-cultural and global mental health education work to medical students and has reported positive results, including improved attitudes towards psychiatry in Somaliland students.CONCLUSIONS: The process of devising, piloting, evaluating, refining, implementing, re-evaluating and again refining the Aqoon model has identified important barriers to successful partnership. This article describes lessons learned during this process, sharing principles and recommendations for readers wishing to expand their own global health link beyond qualified clinicians, to the healthcare professionals of the future.</p
Improving care for fathers with perinatal depression in the community
Full text linkThe perinatal period (from conception to 1 year after birth) is one of biological, psychological, and social transition, requiring adjustment, support, and resources. While the mental health of perinatal women is receiving welcome attention, the absence of clinical guidelines means that the mental health of new fathers (and other non-birthing parents) is likely underassessed. Although around 10% of fathers are reported to experience depression during the perinatal period, the true prevalence is likely to be higher given the lack of screening and barriers to disclosure
Mental healthcare in primary and community-based settings: evidence beyond the WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide
No full textOBJECTIVES: The WHO’s Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) has been widely used in low and middle-income countries. We reviewed literature describing interventions and training programmes beyond the mhGAP-IG, in primary healthcare (PHC) and community-based healthcare (CBH). DESIGN: We searched studies excluded from our updated mhGAP-IG systematic review, and included in other relevant systematic reviews, for evidence and experience of initiatives integrating mental health into PHC and CBH. Our 24 November 2020 mhGAP-IG search encompassed MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie and Google Scholar. Although heterogeneity prevented meta-analysis, we descriptively summarised the evidence-base. RESULTS: Out of 1827 results, we identified 208 relevant records. They described randomised controlled trials of mental health interventions (98 studies, n=55 523 participants), non-randomised studies measuring clinical outcomes (22 studies, n=7405), training outcomes (36 studies, n=12 280) and implementation outcomes (21 studies, n=1090), plus descriptive accounts (18 studies, n=2526), baseline surveys and exploratory studies (6 studies, n=17 093) and commentaries (7 studies). Most (40%) were conducted in the African region, region of the Americas (16%), and South-East Asia (13%). Randomised and non-randomised studies reported improved symptoms, substance use, functioning, parenting and child outcomes. Non-randomised studies reported improved clinical knowledge, confidence and skills following training. CONCLUSIONS: The literature beyond the mhGAP-IG is extensive and shares common findings. Future priorities are less-studied regions, interventions for severe mental illness, exploring ways that mhGAP-IG and alternative approaches complement each other in different contexts and scaling-up mental health integration. PROSPERO registration number CRD42017068459
Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries:a systematic review and meta-analysis
Full text linkBACKGROUND: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs).METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611.FINDINGS: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0·31, 95% CI 0·04 to 0·57, I2=49·4%). No differences in response to intervention were seen in women reporting intimate partner violence for PTSD (eight interventions, n=1436; dSMD 0·14, 95% CI -0·06 to 0·33, I2=42·6%), depression (12 interventions, n=2940; 0·10, -0·04 to 0·25, I2=49·3%), and psychological distress (four interventions, n=1591; 0·07, -0·05 to 0·18, I2=0·0%, p=0·681).INTERPRETATION: Psychological interventions treat anxiety effectively in women with current or recent intimate partner violence exposure in LMICs when delivered by appropriately trained and supervised health-care staff, even when not tailored for this population or targeting intimate partner violence directly. Future research should investigate whether adapting evidence-based psychological interventions for CMDs to address intimate partner violence enhances their acceptability, feasibility, and effectiveness in LMICs.FUNDING: UK National Institute for Health Research ASSET and King's IoPPN Clinician Investigator Scholarship.</p
Problem-based, peer-to-peer global mental health e-learning between the UK and Somaliland: a pilot study
Full text linkBackground WHO’s mental health gap action programme intervention guide (mhGAP-IG) is an evidence-based tool aimed at front-line health workers in low-income and middle-income countries (LMICs). Its potential to improve global mental health education, especially through digital technologies, has been little studied. Problem-based learning (PBL) is usually conducted face-to-face, but its remote application could facilitate cross-cultural education.Objective To evaluate PBL, applied to peer-to-peer global mental health e-learning (Aqoon), using mhGAP-IG.Methods Twelve pairs of UK and Somaliland medical students completed the full programme. Participants self-directedly met online, via the low-bandwidth Medicine Africa website, for PBL-style tutorials focused on modules of the mhGAP-IG, V.2.0. Preparticipation and postparticipation surveys used mixed methods to evaluate Aqoon, including the Attitudes Toward Psychiatry (ATP-30) instrument.Findings Median ATP-30 scores for Somaliland (82.0 vs 95.0, p=0.003) and UK students (82.0 vs 95.0, p=0.011) improved significantly following Aqoon. Qualitative feedback showed that participants valued peer connectivity and learning about cultural and psychosocial differences in their partner’s country. Somaliland students were motivated by clinical learning and UK students by global health education. Feedback on the PBL structure was positive.Conclusions Digital PBL represents an innovative method to extend the benefits of mhGAP-IG beyond front-line clinical staff, to healthcare students in LMICs.Clinical implications Educational resource limitations in LMICs may be overcome using digital platforms and PBL. Replication with non-medical healthcare students is the next step for this model to explore Aqoon’s relevance to pressing global mental health workforce challenges
Training antenatal care providers to deliver brief problem-solving therapy in rural Ethiopia::a developmental evaluation
Full text linkBackground: Task-sharing is the redistribution of tasks usually performed by specialists, to staff with less training and fewer qualifications. Despite the established clinical efficacy of task-shared brief psychological interventions in low and middle-income countries, training and supervision models are infrequently reported and rarely evaluated.Methods: From the interpretive paradigm, we conducted a developmental evaluation of training, supervision, and task-sharing of antenatal care providers (ANCPs) to deliver problem-solving therapy for antenatal depression in rural Ethiopia. We triangulated 18 qualitative interviews with women intervention recipients, ANCPs, mental health specialist trainer/supervisors and research staff, with documentary data. We employed reflexive thematic analysis before ‘peer review’ of our interpretations by a female Ethiopian research assistant.Findings: Four over-arching themes encompassed the developmental journey, impacts, factors influencing success, and improvements. The complex adaptive healthcare system exerted unforeseen effects on the iterative development of training, supervisory and task-sharing plans. High quality communication skills (‘common elements’) training was most valued by ANCPs, while women especially appreciated psychological intervention ‘specific elements.’ An apprenticeship cascade model could balance the need for frequent, in-person specialist supervision against logistical barriers to travel from the capital. Fostering peer ‘communities of practice’ could support ANCPs' well-being and enhance their continued professional development.Conclusions: This study contributes to sparse literature evaluating task-sharing training and supervisory approaches in resource-restricted settings, from an interpretive paradigm. Developmental evaluation proved a flexible methodological approach for exploring perspectives of stakeholders occupying diverse roles. We demonstrate the importance of embedding in-depth pedagogical consideration and qualitative evaluation into trials which depend on high quality clinical education
Achieving the sustainable development goals: investing in early career interdisciplinarity
No full textThe sustainable development goals (SDGs) emphasize the inextricable connections between improved health and wider development indices. This vision is not matched by the ways that progress towards each constituent goal is achieved, and the SDGs are not on track to being met. This commentary considers theories and frameworks capturing the inter-relationships between health and its wider determinants, before discussing examples from mental health and HIV which demonstrate the power of interdisciplinary research. This commentary proposes solutions to integrate wider determinants of health into future research and practice, considering evidence from the PLuS International Interdisciplinary Researchers (PIIR) program between Arizona State University, King’s College London and the University of New South Wales, and how other approaches to interdisciplinary training can enhance clinical-academic progress in the post-COVID-19 era. Despite several frameworks promoting interdisciplinary collaboration, specialists continue to be segregated by funding, training and departmental structures. Early career researchers are well-placed to lead innovative approaches to pressing research questions. International partnership models and interdisciplinary training for early career researchers can expose participants to new perspectives and integrate wider determinants of health into future research and practice. University communities must embrace the need for a radical reimagining of boundaries and connections, if academia, too, is to “build back better.
Cutback management and its effects on comprehensive planning and service delivery: Brooke-Hancock-Jefferson Metropolitan Regional Planning Commission: a case study, 1983
Full text linkThe primary intent of this degree paper is to discuss the functions of the Brooke-Hancock-Jeffersofl (BHJ) Metropolitan Regional Planning Commission, a regional commission in the Upper Ohio Valley, and the effects of decreased funding onthis organizations ability to provide services to area governments. An attempt has also been made to present alternative solutions of reducing staff and personnel without threatening the exist ence of the organization itself. Private and public organiza tions solutions are presented along with those of the writer. Regional planning commissions have played key roles in com municating regional needs to state and federal agencies and offices; initiating or suggesting programs or policies to area governments which would address local problems; and facilitat ing the use of available public funds for local projects. These types of organizations have been instrumental in getting county and municipal governments to work together on issues and prob lems that transcend state, county and local boundaries. How ever, the point of this discussion is how such organizations deal with a decline in funds which would affect the delivery of the aforementioned services. The BHJ Metropolitan Regional Planning Commission is pre sented as an organization that faced the problem, derived and initiated a method of cutting back services and personnel, and retained a high quality and quantity of services rendered. The main sources of information were notes made during the internship experience, books that provided insights on the types of regional planning commissions and the definition of cutback management, and the BHJ Regional Development Plan. Personal interviews were also conducted with practitioners in the field of cutback management
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