Evaluation of the impacts of a district-level mental health care plan on contact coverage, detection and individual outcomes in rural Uganda: a mixed methods 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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Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

BMC Family Practice ◽

10.1186/s12875-021-01496-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rachelle Ashcroft ◽

Catherine Donnelly ◽

Maya Dancey ◽

Sandeep Gill ◽

Simon Lam ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Qualitative Study ◽

Mental Health Care ◽

Focus Groups ◽

Care Delivery ◽

Virtual Care ◽

Primary Care Teams ◽

The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

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Use of Psychiatric Emergency Services and Enrollment Status in a Public Managed Mental Health Care Plan

Psychiatric Services ◽

10.1176/appi.ps.52.11.1494 ◽

2001 ◽

Vol 52 (11) ◽

pp. 1494-1501 ◽

Cited By ~ 11

Author(s):

Dane Wingerson ◽

Joan Russo ◽

Richard Ries ◽

Christos Dagadakis ◽

Peter Roy-Byrne

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Emergency Services ◽

Psychiatric Emergency ◽

Care Plan ◽

Psychiatric Emergency Services ◽

Enrollment Status ◽

Health Care Plan

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

BMC Health Services Research ◽

10.1186/s12913-015-1097-4 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 19

Author(s):

Maji Hailemariam ◽

Abebaw Fekadu ◽

Medhin Selamu ◽

Atalay Alem ◽

Girmay Medhin ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Theory Of Change ◽

Care Plan ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Health Care Plan

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Common Mental Disorders

Kathmandu University Medical Journal ◽

10.3126/kumj.v9i3.6308 ◽

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

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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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Conception of family members of people with mental disorders on self-help groups

Revista Gaúcha de Enfermagem ◽

10.1590/1983-1447.2014.03.41015 ◽

2014 ◽

Vol 35 (3) ◽

pp. 29-35 ◽

Cited By ~ 1

Author(s):

Adriano Brischiliari ◽

Jacqueline Botura Bessa ◽

Maria Angélica Pagliarini Waidman ◽

Sonia Silva Marcon

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Disorders ◽

Mental Health Care ◽

Family Members ◽

Care Plan ◽

Care Services ◽

Self Help ◽

Self Help Groups ◽

Mental Health Association

The aim of this study was to understand how family members of people with mental disorders conceive the performance of self-help groups (SG). This qualitative study was conducted with eleven family members who participate in a SG of the Maringaense Mental Health Association. Data were collected from April to June 2010 during group meetings, in an adjoining room, by means of semi-structured interviews, which were then subjected to content analysis. Two categories emerged: "The group compensates for deficiencies in care", which points out deficiencies arising from the formal care services and the benefits of SG for family members and, "Idealized care", which reveals the expectations of the family in relation to mental health care. It was concluded that family members would like activities of the SG to be incorporated by mental health care services and for family care to become a part of the 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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