Psychiatric Priorities in Developing Countries

1976 ◽  
Vol 128 (6) ◽  
pp. 513-522 ◽  
Author(s):  
R. Giel ◽  
T. W. Harding
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Developing Countries ◽  
Primary Health Care ◽  
Health Services ◽  
Health Workers ◽  
Limited Range ◽  
Primary Health ◽  
Wide Range ◽  
Health Action

SummaryMany psychiatrists assert that an expansion of mental health services in the developing countries is overdue. This will only take place if: (i) the tasks of mental health care are undertaken by a wide range of non-specialist health workers, including those responsible for primary health care; and (ii) services are directed initially at a very limited range of priority conditions. The method of priority selection is discussed, and the process required for translation of priority decisions into health action is exemplified by two illustrations.

scholarly journals Integrating Mental Health into Primary Care Using a Population Based Approach: Six Years Outcome of Aro Primary Care Mental Health Programme for Ogun State, Nigeria

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Workers ◽  
Population Based ◽  
Ogun State ◽  
Primary Health

Introduction: Integration of mental health services into Primary Health Care (PHC) is a proven way of reducing the treatment gap in developing countries. A major constraint to scaling up mental health services in developing countries is scarcity of mental health professionals. A practical solution is to adopt task shifting and task sharing strategies involving Primary Health Care Workers (PHW). One of the major challenges of such integrative services is their long term outcomes and sustainability. The Neuropsychiatric Hospital Aro, Abeokuta, Nigeria embarked on mental health services provision across primary health care facilities in Ogun state six (6) years ago. Objective: This report describes the development, challenges of the programme and presents a post-implementation evaluation after 6 years of its commencement. Methods: Applying a population based expansion of pilot- tested integration model of Aro Primary Care Mental Health Programme (APCMHP) for Ogun State, 80 PHC workers were trained using an adapted mental health Gap Action Programme (mhGAP) intervention guide to assess and treat/refer 5 priority conditions: Psychosis, Depression, Epilepsy, Alcohol and Substance abuse and Other Significant Emotional Complaints (OSEC).There was mental health service provision in 40 designated PHC centers across Ogun state. There was support and supervision of the trained health workers by field supervisors, supplementary training and re-training for skill sustenance, periodic stakeholders meeting with Local Government Service Commission, zonal consultants’ review, financial and other resources commitment by the hospital, monthly programme evaluation and monitoring by the faculty members. We reviewed caseload of patients managed by trained PHC Workers since commencement of the programme in November 2011 till October 2017 (6 years period) using descriptive statistics. Appropriate ethical approval was obtained. Results: During the six-year period (November 2011-October 2017), 2194 cases (average of 366 new cases yearly) were identified and treated by Trained Health Workers (THWs). About 90% of cases were Psychosis and Epilepsy. There was a steady attrition of THWs and at the end of the sixth year only 29% of the THWs remained within the programme. Treatment outcomes were fair as over 50% of patients had ≥ 3 follow-up visits, symptom remission of ≥ 30% and a subjective improvement in Global Ratings. Conclusion: Our project has demonstrated that it is feasible, practicable and cost effective with community acceptance to scale up mental health services at primary care setting in Nigeria using adapted mhGAP-IG document. The need to understand the dynamics and econometrics of sustainable primary mental health services is indicated.

scholarly journals Perception of service users and their caregivers on primary care-based mental health services: a qualitative study in Nepal

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
N. P. Luitel ◽  
M. J. D. Jordans ◽  
P. Subba ◽  
I. H. Komproe
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Workers ◽  
Service Users ◽  
Care Providers ◽  
Primary Health

Abstract Background Integration of mental health services into primary health care systems has been advocated as a strategy to minimize the tremendous mental health treatment gap, particularly in low- and middle-income countries. Barriers to integration of mental health into primary health care have been widely documented; however, very little is known about the perception of service users and their caregivers on primary care-based mental health services. This study assessed service users’ and caregivers’ perceptions of mental health services provided by trained primary health care workers in Nepal. Methods A qualitative study was conducted among people with depression, psychosis, alcohol use disorder and epilepsy, and their caregivers in Chitwan, a district in southern Nepal. Semi-structured interviews were conducted with 43 service users and 38 caregivers to assess their perceptions about the accessibility of the services, types of services they received, skills and competencies of health care providers, satisfaction and barriers to receiving services. Results Overall, both service users and caregivers were satisfied with the mental health services provided by primary health care providers. They also perceived health workers to be competent and skillful because the services they received were effective in reducing their mental health problems. Both psychological and pharmacological services were made available free of cost, however, they considered psychological services more effective than pharmacological treatment. Major challenges and difficulties accessing services were associated with frequent transfer of trained health workers, non-availability of the same health care provider at follow-ups, frequent stock-out of medicines or non-availability of required medicines, lack of a confidential space for consultation in health facilities, and stigmatizing and negative behavior of some health workers. Conclusion The results demonstrated that both service users and caregivers perceived primary care-based mental health services to be accessible, acceptable and effective. The key recommendations emerging from this study for improving mental health services in primary care include the provision of a separate cadre of psychosocial workers to provide psychological interventions, developing quick and efficient mechanisms for the procurement and supply of psychotropic medicines, establishing a confidential place within health facilities for consultation, and further training of health workers to reduce stigma.

Childhood Mental Disorders in Primary Health Care: Results of Observations in Four Developing Countries

PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 677-683
Author(s):  
R. Giel ◽  
M. V. de Arango ◽  
C. E. Climent ◽  
T. W. Harding ◽  
H. H. A. Ibrahim ◽  
...  
Keyword(s):  
Health Care ◽  
Developing Countries ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Health Workers ◽  
Health Care Facilities ◽  
Primary Health ◽  
Care Facilities ◽  
Research Procedure ◽  
Primary Health Care Facilities

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Colombia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to that encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The results have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

scholarly journals Integrating Mental Health Services into the Primary Health Care System: The Need for Reform in Iran

2021 ◽  
Author(s):  
Ahmad Hajebi ◽  
Vandad Sharifi ◽  
Maryam Abbasinejad ◽  
Ali Asadi ◽  
Nahid Jafari ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Literature Review ◽  
Financial Resources ◽  
Primary Health Care System ◽  
Primary Health ◽  
Integrated Mental Health

Objective: The main objective of this study was to review aspects of the current situation and structure of the integrated mental health care services for planning a reform. Aspects of the newly designed infrastructure, along with specification of duties of the various human resources, and its relation with Iran’s Comprehensive Mental and Social Health Services (the SERAJ Program), will also be presented Method: This is a study on service design and three methods of literature review, deep interview with stakeholders, and focused group discussions. In the literature review, national and international official documents, including official reports of the World Health Organization (WHO) and consultant field visits, were reviewed. Deep semi-structured interviews with 9 stakeholders were performed and results were gathered and categorized into 3 main questions were analyzed using the responsibility and effectiveness matrix method. The Final results were discussed with experts, during which the main five-domain questions were asked and the experts’ opinions were observed. Results: In this study, the main gaps of the public mental health care (PHC) services in Iran were identified, which included reduction of risk factors for mental disorders, training the general population, early recognition and treatment of patients with mental disorders, educating patients and their families, and rehabilitation services. The new model was then proposed to fill these gaps focusing on increasing access, continuity of care, coordination in service delivery, and comprehensiveness of care. A mental health worker was placed besides general healthcare workers and general practitioners (GPs). Services were prioritized and the master flowchart for mental health service delivery was designed. Conclusion: A reform was indeed necessary in the integrated mental health services in Iran, but regarding the infrastructure needed for this reform, including human and financial resources, support of the senior authorities of the Ministry of Health (MOH) is necessary for the continuity and enhancement of services. In this model, attention has been given to the principles of integrating mental health services into primary health care. Current experience shows that the primary health care system has been facing many executive challenges, and mental health services are not exclusion to this issue. Monitoring and evaluation of this model of service and efforts for maintaining sustainable financial resources is recommended to make a reform in this system and to stabilize it.

scholarly journals The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox’s Bazar, Bangladesh

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0253013
Author(s):  
Rosanna Jeffries ◽  
Hassan Abdi ◽  
Mohammad Ali ◽  
Abu Toha Md Rezuanul Haque Bhuiyan ◽  
Mohamed El Shazly ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Reproductive Health ◽  
Health Services ◽  
Sexual And Reproductive Health ◽  
Health Sector ◽  
Advisory Group ◽  
Primary Health ◽  
Working Groups

On August 25 2017, an unprecedented influx of Rohingya refugees began from Rakhine State in Myanmar into Bangladesh’s district of Cox’s Bazar. The scale and acuteness of this humanitarian crisis was unprecedented and unique globally, requiring strong coordination of a multitude of actors. This paper reflects on the health sector coordination from August 2017 to October 2019, focusing on selected achievements and persisting challenges of the health sector strategic advisory group (HSSAG), and the health sector working groups including epidemiology and case management, sexual and reproductive health, community health, mental health and psychosocial support, and emergency preparedness. In the early days of the response, minimum service standards for primary health care were established, a fundamental initial step which enabled the standardization of services based on critical needs. Similarly, establishing standards for community health outreach was the backbone for capitalizing on this important health workforce. Novel approaches were adopted for infectious disease responses for acute watery diarrhoea and varicella, drawing on inter-sectoral collaborations. Sexual and reproductive health services were prioritized from the initial onset of the crisis and improvements in skilled delivery attendance, gender-based violence services, abortion care and family planning were recorded. Mental health service provision was strengthened through community-based approaches although integration of mental health programmes into primary health care has been limited by availability of specialist psychiatrists. Strong, collaborative and legitimate leadership by the health sector strategic advisory group, drawing on inter-sectoral collaborations and the technical expertise of the different technical working groups, were critical in the response and proved effective, despite the remaining challenges to be addressed. Anticipated reductions in funding as the crisis moves into protracted status threatens the achievements of the health sector in provision of health services to the Rohingya refugees.

scholarly journals Mental health in primary health care: professionals’ perceptions and patients’ levels of depression, anxiety and stress

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Tatiana Varela Madureira ◽  
Maria Cristina Quintas Antunes
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Mental Health Care ◽  
Health Professionals ◽  
Mental Health Problems ◽  
Anxiety And Depression ◽  
Self Administration ◽  
Primary Health

Background: The integration of mental health in primary health care, throughout its various functional units and with effective articulation between primary health care and mental health services, has been considered an essential objective of the legislative documents produced in the last three decades in Portugal, among them the National Health Plan 2011-2016.Goals: This study aimed to inquire health professionals’ perceptions about mental health care provided by public primary health care units, namely their perceptions about the mental health of their patients. It also intended to explore the difficulties perceived by the health professionals in their daily activity about the mental health problems of their patients and about the need of clinical psychologists’ activity in the public primary health care.Methods: This is an observational cross-sectional study with two non-probabilistic samples: health professionals (doctors, nurses and psychologists) and patients from two public health care units. Health professionals were interviewed (individual structured face-to-face interviews) about their perceptions of needs for improving their capacity to provide mental healthcare and about patients’ mental health conditions. Patients responded (by self-administration) to the Depression, Anxiety and Stress Scale (DASS-21), providing a characterization of patients’ stress, anxiety and symptoms of depression.Results: Health professionals in their daily practice often identify in their patients symptoms of stress, anxiety and depression (most particularly in adults),. Several issues were identified as problematic, such as: poor access of the referral system for psychiatric and clinical psychological specialized care, insufficient number of health professionals, particularly of psychologists, and lack of appropriate mental health care specialization. The results also revealed relevant levels of stress, anxiety and depression in primary health care patients (both genders), which seem to increase with age. Discussion: Difficulties identified by health professionals may relate to the centralisation of resources, resistance to change from human resources management, lack of consensus among the various decision groups linked to mental health and, at institutional level, insufficient and inadequate funding. These factors may contribute to a failure in early diagnosis of symptoms of depression, anxiety and stress. It is expected that articulation between primary health services and differentiated health services will improve, with improvement in teamwork among professionals and increase of the quality of life of users, satisfaction with work, from health professionals,  and reduction of health costs.

Expanding the Role of Primary Health Care in the Provision of Mental Health Services to the Population of the Kyrgyz Republic

2017 ◽  
Vol 41 (S1) ◽  
pp. S606-S606
Author(s):  
T. Galako
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Mental Health Care ◽  
Kyrgyz Republic ◽  
Family Doctors ◽  
Primary Health

Providing comprehensive, integrated services in the field of mental health in primary health care (PHC) is a component of the state mental health program for the population of the Kyrgyz republic (KR) in the 2017–2030 biennium. In order to develop an action plan in this area a situational analysis of resources of psychiatric care at PHC level was carried out. There was revealed a significant deficit of specialists, such as family doctors, mental health care professionals. In spite of the need for 3,300 family doctors, only 1706 work, and 80% of them are of retirement age.The results of a research showed a low level of knowledge and skills of family physicians for the early detection of mental disorders and provision of appropriate medical care. There are also a limited number of psychiatrists, especially in rural regions (77% of the required quantity).During recent years, there have been implemented significant changes in the system of mental health services, aimed at improving its quality, the approach to the place of residence of the patient and the prevalence of psychosocial services.Since 2016 in 8 southern regions in the Kyrgyz Republic has been introduced a new model for the provision of comprehensive health care services. Piloting this model involves psychosocial rehabilitation of patients with mental disorders, the help of mobile teams at the place of patient residence, as well as psychoeducation, training, and support to family doctors. These and other measures will help to optimise mental health care at PHC level.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

scholarly journals Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries.

1983 ◽  
Vol 73 (9) ◽  
pp. 1081-1084 ◽  
Author(s):  
L L Ignacio ◽  
M V de Arango ◽  
J Baltazar ◽  
E D Busnello ◽  
C E Climent ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Developing Countries ◽  
Primary Health Care ◽  
Mental Health Problems ◽  
Health Problems ◽  
Health Care Personnel ◽  
Knowledge And Attitudes ◽  
Primary Health
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