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

2017 ◽  
Vol 4 ◽  
Author(s):  
A. Humayun ◽  
I. Haq ◽  
F. R. Khan ◽  
N. Azad ◽  
M. M. Khan ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Primary Care Physicians ◽  
Psychosocial Support ◽  
Common Mental Disorders ◽  
Care Staff ◽  
Humanitarian Crisis ◽  
Internally Displaced ◽  
Primary Care Staff

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.

scholarly journals Chinese perspectives on primary care for common mental disorders: Barriers and policy implications

2018 ◽  
Vol 64 (5) ◽  
pp. 417-426 ◽  
Author(s):  
Kai Sing Sun ◽  
Tai Pong Lam ◽  
Dan Wu
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Primary Care Physicians ◽  
Common Mental Disorders ◽  
Chinese Patient ◽  
Policy Implications ◽  
World Health

Background: The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China. Aims: This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings. Methods: A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed. Results: Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time. Conclusion: Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients’ intention to seek help and PCPs’ competency in mental health care are other fundamental factors to be addressed.

scholarly journals O3.6. PREVALENCE OF AND RECOVERY FROM COMMON MENTAL DISORDERS INCLUDING PSYCHOTIC EXPERIENCES

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S8-S8
Author(s):  
Jesus Perez ◽  
Clare Knight ◽  
Debra A Russo ◽  
Jan Stochl ◽  
Peter B Jones
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorders ◽  
Common Mental Disorders ◽  
Psychotic Experiences ◽  
Recovery Rates ◽  
Psychological Therapies ◽  
Primary Mental Health Care ◽  
Threshold Score

Abstract Background Systematic reviews indicate that approximately one third of people with at-risk mental states for psychosis (ARMS) will transition to a psychotic disorder. Research in non-specialised services, such as primary care settings, has shown that far fewer make such a conversion. Nonetheless, psychotic experiences (PE) may also be linked to common mental disorders (CMD), particularly depression and anxiety, and still predict poor outcomes. Population studies modelling the co-occurrence of CMD and PE have found an underlying unitary psychopathological factor, with PE emerging towards its more severe end. We know little about the prevalence of and recovery from PE in primary mental health care, where most CMD are treated. One example of primary mental health care setting in England is the Improving Access to Psychological Therapies (IAPT) programme (https://www.england.nhs.uk/mental-health/adults/iapt/). The IAPT programme provides evidence-based psychological therapies for mild to moderate CMD across the UK National Health Service (NHS). IAPT services adhere to current diagnostic paradigms and, therefore, do not either measure or treat PE. We aimed to establish the prevalence of PE in a large sample of patients with CMD from the IAPT programme and compare recovery rates between patients with CMD and PE (CMD-P) and those without PE. Methods We used the Community Assessment of Psychic Experiences - Positive 15-item Scale (CAPE-P15) to determine the prevalence of PE in patients with CMD receiving treatment from IAPT services across England. We employed the CAPE-P15 threshold score of 1.47, which identifies individuals with ARMS, and also a lower threshold of 1.30, chosen as within one standard error of measurement, in order to explore threshold effects in the association between PE and recovery. Patient-reported measures of depression (PHQ-9) and anxiety (GAD-7) are routinely collected in IAPT services and determine ‘caseness’ before, during and after therapy. Using recovery rates (moving from ‘caseness’ to recovery) monitored nationally in the IAPT programme, we stratified patients according to the absence and presence of PE. Multi-group growth models estimated improvement trajectories for each group. Results 2,042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The overall prevalence of CMD-P was 29.68% at CAPE-P15 threshold score for ARMS, i.e. 1.47, and 48.09% at threshold score 1.30. The overall recovery rate at threshold of 1.47 was 27.87% and 36.3% at 1.30. Recovery rates for those without PE were 58.92% and 62.43% for thresholds 1.47 and 1.30, respectively. Although patients with or without PE shared similar improvement trajectories, the initial severity of patients with CMD-P impeded their likelihood of recovery during treatment. Discussion At least one in four patients receiving treatment from IAPT services in primary care experience CMD-P. This significant group of people experience a lower recovery rate, with adverse implications not only for them but also for efficiency of services. Although recovery trajectories for this group showed improvement over therapy sessions, remittance of symptoms was insufficient to meet national IAPT standards of recovery. This patient group is not well-served by current interventions in primary care. This work forms part of a nation-wide NIHR research programme (TYPPEX; https://www.nihr.ac.uk/news/innovative-mental-health-study-launchesin-eastern-region) aiming to develop innovative therapies for people with CMD-P in primary care. Preliminary results related to feasibility and effectiveness of new therapeutic approaches will also be presented.

scholarly journals Who Should Play a Key Role in Preventing Common Mental Disorders that Affect Employees in the Workplace? Results of a Survey with Occupational Health Physicians, Primary Care Physicians, Psychotherapists, and Human Resource Managers

2019 ◽  
Vol 16 (8) ◽  
pp. 1383 ◽  
Author(s):  
Martina Michaelis ◽  
Elisabeth Maria Balint ◽  
Florian Junne ◽  
Stephan Zipfel ◽  
Harald Gündel ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Occupational Health ◽  
Health Professionals ◽  
Primary Care Physicians ◽  
Common Mental Disorders ◽  
Human Resource Managers ◽  
Insurance Agents ◽  
Professional Groups ◽  
Resource Managers

The rising burden of common mental disorders (CMDs) in employees requires strategies for prevention. No systematic data exist about how those involved perceive their roles, responsibilities, and interactions with other professional groups. Therefore, we performed a multi-professional standardized survey with health professionals in Germany. A self-administered questionnaire was completed by 133 occupational health physicians (OHPs), 136 primary care physicians (PCPs), 186 psychotherapists (PTs), and 172 human resource managers (HRMs). Inter alia, they were asked which health professionals working in the company health service and in the outpatient care or in the sector of statutory insurance agents should play a key role in the primary, secondary, and tertiary prevention of CMDs in employees. The McNemar test was used in order to compare the attributed roles among the professionals involved. With regard to CMDs, all the professional groups involved in this study declared OHPs as the most relevant pillar in the field of prevention. In primary prevention, HRMs regarded themselves, OHPs, and health insurance agents as equally relevant in terms of prevention. PTs indicated an important role for employee representatives in this field. In secondary prevention, PCPs were regarded as important as OHPs. HRMs indicated themselves as equally important as OHPs and PCPs. In tertiary prevention, only OHPs identified themselves as main protagonists. The other groups marked a variety of several professions. There is a common acceptance from the parties involved that might help the first steps be taken toward overcoming barriers, e.g., by developing a common framework for quality-assured intersectional cooperation in the field of CMD prevention in employees.

QOL in primary care of elderly mentally ill and their caregivers’ well-being

2011 ◽  
Vol 26 (S2) ◽  
pp. 859-859
Author(s):  
N. Tataru ◽  
A. Dicker
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Primary Care ◽  
Mental Disorders ◽  
Mental Health Problems ◽  
Well Being ◽  
The Elderly ◽  
Care Staff ◽  
Care Of Elderly

It is difficult to talk about quality of life of elderly with mental disorders. Thus, there appeared serious ethical challenges for psychiatry: to cut mental health costs and to provide care to as many as possible through all duration of their diseases, from the onset to the end-of-life. The psychiatrists have to face these challenges and treat the elderly with or without mental disorders from primary care to residential one, assuring them the best quality of life as it is possible. The goal of medical policy is to optimize the patients’ and their caregivers’ well-being. Multiple loses in old age are important in decreasing of quality of life and increasing of mental health problems in the elderly. They have more social and medical problems, which include depression and suicide. Caring for a family member with dementia can be both challenging and stressful. Primary care-staff need to develop the skills to detect and manage signs of caregivers stress. Health care professionals can promote well-being of the caregivers not only the patients’ well-being, educate them how to access help and manage their stress effectively. Recognition of the importance of the role of caregivers and finding the effective ways of supporting them, respecting their personal perception of the quality of this offer, improve the quality of primary care of elderly patients with mental disorders and also improve the quality of life of their relative or caregivers.

scholarly journals Primary care physicians’ use of the proposed classification of common mental disorders for ICD-11

2017 ◽  
Vol 34 (5) ◽  
pp. 574-580 ◽  
Author(s):  
David P Goldberg ◽  
Tai-Pong Lam ◽  
Fareed Minhas ◽  
Bushra Razzaque ◽  
Rebeca Robles ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Disorders ◽  
Primary Care Physicians ◽  
Common Mental Disorders

scholarly journals Common mental disorders in Petrópolis-RJ: a challenge to integrate mental health into primary care strategies

2011 ◽  
Vol 33 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Sandra Fortes ◽  
Claudia S. Lopes ◽  
Luiz A. B. Villano ◽  
Mônica R. Campos ◽  
Daniel A. Gonçalves ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Primary Care ◽  
Mental Disorders ◽  
Family Income ◽  
Common Mental Disorders ◽  
Family Health ◽  
Special Group ◽  
Health Strategy ◽  
Family Health Strategy

OBJECTIVE: Common mental disorders are present in more than 50% of patients attending primary care clinics. The main objectives of this study were to detect whether there is any special group of patients within the Family Health Strategy that should be considered to be in greater risk for common mental disorders and to recommend alternative interventions to aid these patients. METHOD: In 2002, a cross-sectional study on common mental disorders seen at Family Health Strategy centers was conducted in Petrópolis, State of Rio de Janeiro. RESULTS: Common mental disorders were associated with women (OR = 2.90; 95% CI 1.82-4.32), younger than 45 years of age (OR = 1.43; 95% CI 1.02-2.01), with a monthly per capita family income of less than US$40.00 (OR = 1.68; 95% CI 1.20-2.39), and without a partner (OR = 1.71; 95% CI 1.22-2.39). Illiteracy was associated with common mental disorders among patients who were not extremely poor. Social support networks such as going often to church (OR = 0.62; 95% CI 0.43-0.89); participating in artistic and sporting activities (OR = 0.42; 95% CI 0.26-0.70) and having at least four trusted relatives or friends (OR = 0.53; 95% CI 0.31-0.91) was inversely associated with common mental disorders. DISCUSSION: Poor women with little social support represent a special group at risk for common mental disorders in the primary care setting. Some countries have developed special interventions to treat patients with common mental disorders in primary care. CONCLUSION: Mental health care programs could include evidence-based psychosocial interventions to assist women in overcoming the vicious circle of poverty and dealing with their mental disorders.

scholarly journals Common Mental Disorders

2012 ◽  
Vol 9 (3) ◽  
pp. 213-217
Author(s):  
A Risal
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Disorders ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Common Mental Disorders ◽  
Economic Status ◽  
Pathways To Care ◽  
Middle Income

Common mental disorders are a group of distress states manifesting with anxiety, depressive and unexplained somatic symptoms typically encountered in community and primary care settings. Risk factors for these disorders are mainly lower socio-economic status, psychological illnesses, poor reproductive health, gender disadvantage and physical ill-health. WHO has recommended that treatment of all these disorders should be based in primary care to be more effective and accessible to all the community people. The structure of mental health care in primary care is generally understood in terms of the “pathways to care” model and it plays a major role in countries like ours where community-based mental health services do not exist. Both the psychological and pharmacological therapies are found to be equally effective for treating these disorders. Integration of mental health into primary care can be considered as the stepping stone in the way forward to tackle the barriers and problems in effective management of common mental disorders in the community. The acute shortage of mental health professionals and the relatively low levels of awareness about mental disorders make it mandatory that primary health care should remain the single largest sector for mental health care in low and middle income countries like ours.DOI: http://dx.doi.org/10.3126/kumj.v9i3.6308 Kathmandu Univ Med J 2011;9(3):213-7  

scholarly journals Improving referrals from primary care to secondary mental health services through an educational intervention: experience from Qatar

2021 ◽  
pp. 1-4
Author(s):  
Ovais Wadoo ◽  
Sami Ouanes ◽  
Mohamed Ali Siddig Ahmed ◽  
Iman Saeed Ahmed Saeid ◽  
Samya Ahmad AlAbdulla ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Educational Intervention ◽  
Common Mental Disorders ◽  
Clinical Information ◽  
Health Clinic

Primary care is geared to manage patients with mild to moderate presentations of common mental disorders and to refer patients with more severe mental disorders to specialist mental health services. With growing demand for specialty care, the quality of the referral is increasingly important to ensure efficient patient flow across the primary/secondary care interface and appropriate use of secondary services. We report on an initiative in a Qatari mental health clinic to improve the quality of referrals from primary care to specialist mental health services through an educational intervention for family physicians. We highlight the problem, the intervention and the outcome of our initiative, which was the first of its kind in the region. The number of inappropriate referrals fell by 93%, and the number of referrals with inadequate clinical information declined from 15 (January 2019) to 1 (September 2019). Feedback was very positive; respondents reported feeling supported, with better understanding of care pathways, the scope of primary care and mental health services.

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