Developing a mental health care plan in a low resource setting: the theory of change approach

Abstract Background The burden of mental disorders in low- and middle-income countries is large. Yet there is a major treatment gap for these disorders which can be reduced by integrating the care of mental disorders in primary care. Aim We aimed to evaluate the impact of a district mental health care plan (MHCP) on contact coverage for and detection of mental disorders, as well as impact on mental health symptom severity and individual functioning in rural Uganda. Results For adults who attended primary care facilities, there was an immediate positive effect of the MHCP on clinical detection at 3 months although this was not sustained at 12 months. Those who were treated in primary care experienced significant reductions in symptom severity and functional impairment over 12 months. There was negligible change in population-level contact coverage for depression and alcohol use disorder. Conclusion The study found that it is possible to integrate mental health care into primary care in rural Uganda. Treatment by trained primary care workers improves clinical and functioning outcomes for depression, psychosis and epilepsy. Challenges remain in accessing the men for care, sustaining the improvement in detection over time, and creating demand for services among those with presumed need.

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Change in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder: a repeat cross sectional community survey in Nepal

10.21203/rs.2.12708/v2 ◽

2019 ◽

Author(s):

Nagendra Prasad Luitel ◽

Emily C Garman ◽

Mark JD Jord ◽

Crick Lund

Keyword(s):

Mental Health ◽

Health Care ◽

Alcohol Use ◽

Mental Health Care ◽

Alcohol Use Disorder ◽

Care Plan ◽

Cross Sectional ◽

Treatment Coverage ◽

Health Care Plan

Abstract Background: Despite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal. Methods: The repeat population-based cross-sectional community survey was conducted with randomly selected adults in the baseline (N=1983) and the follow-up (N=1499) surveys, 3 years and 6 months apart. The Patient Health Questionnaire and Alcohol Use Disorder Identification Test were used to screen people with probable depression and AUD. Barriers to seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE). Results: The proportion of the participants receiving treatment for depression increased by 3.7 points (from 8.1% in the baseline to 11.8% in the follow-up) and for AUD by 5.2 points (from 5.1% in the baseline to 10.3% in the follow-up study), however, these changes were not statistically significant. There was no significant reduction in the overall BACE score in both unadjusted and adjusted models for both depression and AUD. The possible reasons for non-significant changes in treatment coverage and barriers to care could be that (i) the method of repeat population level surveys with a random sample was too distal to the intervention to be able to register a change and (ii) the study was underpowered to detect such changes. Conclusion: The study found non-significant trends for improvements in treatment coverage and barriers to mental health care following implementation of the district mental health care plan. The key areas for improvement in the current strategy to improve treatment coverage and barriers to mental health care included change in the content of the existing community sensitization program, particularly for changing attitude and intention of people with mental illness for seeking care.

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Quality assessment in a Medicaid managed mental health care plan: An Iowa case study.

American Journal of Orthopsychiatry ◽

10.1037/h0080416 ◽

1999 ◽

Vol 69 (3) ◽

pp. 410-414 ◽

Cited By ~ 5

Author(s):

Barbara M. Rohland

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Quality Assessment ◽

Care Plan ◽

Health Care Plan

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Mental health care in Nepal: current situation and challenges for development of a district mental health care plan

Conflict and Health ◽

10.1186/s13031-014-0030-5 ◽

2015 ◽

Vol 9 (1) ◽

Cited By ~ 59

Author(s):

Nagendra P Luitel ◽

Mark JD Jordans ◽

Anup Adhikari ◽

Nawaraj Upadhaya ◽

Charlotte Hanlon ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Current Situation ◽

Care Plan ◽

Health Care Plan

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Change in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder: a repeat cross sectional community survey in Nepal

BMC Public Health ◽

10.1186/s12889-019-7663-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Nagendra P. Luitel ◽

Emily C. Garman ◽

Mark J. D. Jordans ◽

Crick Lund

Keyword(s):

Mental Health ◽

Health Care ◽

Alcohol Use ◽

Mental Health Care ◽

Alcohol Use Disorder ◽

Care Plan ◽

Cross Sectional ◽

Treatment Coverage ◽

Health Care Plan

Abstract Background Despite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal. Methods The repeat population-based cross-sectional community survey was conducted with randomly selected adults in the baseline (N = 1983) and the follow-up (N = 1499) surveys, 3 years and 6 months apart. The Patient Health Questionnaire and Alcohol Use Disorder Identification Test were used to screen people with probable depression and AUD. Barriers to seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE). Results The proportion of the participants receiving treatment for depression increased by 3.7 points (from 8.1% in the baseline to 11.8% in the follow-up) and for AUD by 5.2 points (from 5.1% in the baseline to 10.3% in the follow-up study), however, these changes were not statistically significant. There was no significant reduction in the overall BACE score in both unadjusted and adjusted models for both depression and AUD. The possible reasons for non-significant changes in treatment coverage and barriers to care could be that (i) the method of repeat population level surveys with a random sample was too distal to the intervention to be able to register a change and (ii) the study was underpowered to detect such changes. Conclusion The study found non-significant trends for improvements in treatment coverage and barriers to mental health care following implementation of the district mental health care plan. The key areas for improvement in the current strategy to improve treatment coverage and barriers to mental health care included change in the content of the existing community sensitization program, particularly for changing attitude and intention of people with mental illness for seeking care.

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