Community mental health work – WHO recommendations and the perspective of people experiencing mental health problems

This article was written in response to the publication by the World Health Organization of a document containing recommendations and a toolkit for promoting mental health and addressing the problems of people with mental disorders (Mental Health Gap Action Programme – mhGAP). The conclusions in the WHO proposal were compared with the perspective of people in mental crisis, which was reconstructed through qualitative research (in the interpretative paradigm). The analysis of the empirical material, which consisted of 35 autobiographical narrative interviews with people who have experienced mental disorders, showed that the WHO proposals correspond to the needs declared by the people struggling with mental problems. The compliance concerns both the expected fields of action (fight against stereotypes, prevention, health promotion) and methods (activities in the residential environment of people in need of support). At the same time, however, the analysis revealed a number of elements worth noting when orienting future community mental health work. These elements include: the increasing role and importance of people experiencing mental disorders in the orientation of action, strengthening community co-creation with people experiencing a mental disorder, moving away from one-sided teaching and training towards collaborative learning.

Mental Health Gap Action Programme training in Nigeria: reflections for progressive learning among primary care workers

In the majority of low- and middle-income countries, mental healthcare is delivered by primary care workers. Often, they are the only contact for patients and their families. Although their knowledge base can be limited, they are expected to manage complex cases with few resources. The authors describe their experience of partnership with mental health centres set up by the Nigeria Health Care Project, and training their primary care workers based on the World Health Organization's Mental Health Gap Action Programme. Although the programme was very effective in helping to upskill their knowledge and experience, a need for continued professional development was highlighted. Based on their feedback, multiple evidence-based options are explored, including the use of remote learning and social media (increased significantly around the world because of the COVID-19 pandemic), to help primary care workers improve their knowledge base and maintain their competencies with the limited resources available.

Durum Wheat Yield and N Uptake as Affected by N Source, Timing, and Rate in Two Mediterranean Environments

In nitrate vulnerable zones (NVZs), site-specific techniques are needed to match N availability with durum wheat (Triticum turgidum subsp. durum Desf.) requirements. Enhanced-efficiency fertilizers can improve efficient N supply and reduce leaching, contributing to sustainable agriculture. Two-year field experiments were carried out at two Mediterranean nitrate vulnerable zones in Central Italy (Pisa and Arezzo) to study the effects of nitrogen sources, timings, and application rates. The trial compared: (i) three N sources for the first topdressing application (urea, methylene urea, and urea with the nitrification inhibitor DMPP); (ii) two stages for the first topdressing N application (1st tiller visible—BBCH21 and 1st node detectable—BBCH31); (iii) two N rates: one based on the crop N requirements (Optimal—NO), the other based on action programme prescriptions of the two NVZs (Action Programme—NAP). Grain yield and yield components were determined, together with N uptake. The results showed that: (i) grain and biomass production were reduced with NAP at both locations; (ii) urea performed better than slow-release fertilizers; (iii) the best application time depended on the N source and location: in Pisa, enhanced-efficiency fertilizers achieved higher yields when applied earliest, while for urea the opposite was true; in Arezzo different N fertilizers showed similar performances between the two application timings. Different behaviors of topdressing fertilizers at the two localities could be related to the diverse patterns of temperatures and rainfall. Thus, optimal fertilization strategies would seem to vary according to environmental conditions.

Implementation of the Mental Health Gap Action Programme (mhGAP) in Kosrae State in the Federated States of Micronesia

Improving access to mental health care is a global health priority, and a significant treatment gap exists in Pacific Island Countries. One strategy to bridge the gap is the World Health Organization’s Mental Health Gap Action Programme (mhGAP), which provides evidence-based guidance for managing mental, neurological, and substance abuse conditions. mhGAP has been implemented in more than 90 countries, but there has been limited training within many Pacific Island countries. We describe implementation of mhGAP training in Kosrae, a state within the Federated States of Micronesia. mhGAP training was conducted with 18 members of the Kosrae Community Health Center (KCHC). Our training model included 2 helpful modifications: (1) participants attended a combination of online sessions and a 1-week in-person training, which allowed for more time and flexibility in delivering training; and (2) longitudinal support posttraining, which has been identified as an important factor in successful implementation of mhGAP.

THE EMERGING ROLE(S) OF LAW IN REPRODUCTIVE HEALTH CARE IN NIGERIA: A COMPARATIVE ANALYSIS

<span lang="EN-GB">There is no gainsaying the fact that the ICPD Call for Action Programme and the Beijing Conference has had pivotal roles in the evolution and growth of Reproductive Health Laws. These reproductive health laws in turn have served as a means of resolution to Reproductive health issues which include but are not limited to issues such as early and under-aged marriage, adolescent pregnancy, harmful traditional practices examples of which include Female Genital Mutilation (FGM), widowhood practice, domestic violence, abortion, HIV/AIDS, Maternal mortality/morbidities and improper family planning. Many challenges remain in the effort to address these health issues. The major setback has been the failure of state parties (countries) to incorporate these International Reproductive Health Care instruments into their legal system as well as the implementation of these laws. This paper highlights the legality of the ICPD in the context of International Law and also focuses on the emerging roles of laws in Reproductive Health Care in Nigeria</span>

The Impact of the Climate Action Programme 2030 and Federal State Measures on the Uptake of Renewable Heating Systems in Lower Saxony’s Building Stock

A heating transition is urgently needed to fulfil the national CO2 reduction targets in Germany. Thus, in 2019, there has been a strong policy push towards increasing the share of renewables in heating through the introduction of the Climate Action Programme 2030 and the reform of existing policies. In addition to the policy landscape on the national level, federal states have further leeway to implement policies; these options are currently largely unresearched. In order to fill this gap, we developed a System Dynamics Model for Lower Saxony to determine the effect of recent policy changes as well as additional regional subsidy schemes on the heating market. The results show that even though changes in subsidies can increase the renewable uptake considerably, the CO2e and energy demand reduction targets are not met in any of the examined scenarios. Furthermore, the model shows that policy formulation must take the inertia of the sector into account and completely turn away from fossil fuels to reach the stipulated emission reductions.

WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact

QuestionThere is a large worldwide gap between the service need and provision for mental, neurological and substance use disorders. WHO’s Mental Health Gap Action Programme (mhGAP) intervention guide (IG), provides evidence-based guidance and tools for assessment and integrated management of priority disorders. Our 2017 systematic review identified 33 peer-reviewed studies describing mhGAP-IG implementation in low-income and middle-income countries.Study selection and analysisWe searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie, Google Scholar and citations of our review, on 24 November 2020. We sought evidence, experience and evaluations of the mhGAP-IG, app or mhGAP Humanitarian IG, from any country, in any language. We extracted data from included papers, but heterogeneity prevented meta-analysis.FindingsOf 2621 results, 162 new papers reported applications of the mhGAP-IG. They described mhGAP training courses (59 references), clinical applications (n=49), research uses (n=27), contextual adaptations (n=13), economic studies (n=7) and other educational applications (n=7). Most were conducted in the African region (40%) and South-East Asia (25%). Studies demonstrated improved knowledge, attitudes and confidence post-training and improved symptoms and engagement with care, post-implementation. Research studies compared mhGAP-IG-enhanced usual care with task-shared psychological interventions and adaptation studies optimised mhGAP-IG implementation for different contexts. Economic studies calculated human resource requirements of scaling up mhGAP-IG implementation and other educational studies explored its potential for repurposing.ConclusionsThe diverse, expanding global mhGAP-IG literature demonstrates substantial impact on training, patient care, research and practice. Priorities for future research should be less-studied regions, severe mental illness and contextual adaptation of brief psychological interventions.

The Implementation of the WHO Mental Health Gap Intervention Guide (mhGAP-IG) in Ukraine, Armenia, Georgia and Kyrgyz Republic

Despite the increasing burden of mental disorders, a lot of people worldwide suffer a gap in receiving necessary care in these countries. To close this gap, the WHO has developed mhGAP training modules aimed at scaling up mental health and substance use disorders services, especially in low- and middle-income countries. This article presents the experience of implementing the Mental Health Gap Action Programme (mhGAP) in Ukraine, Armenia, Georgia, and Kyrgyz Republic. Data were gathered from an electronic questionnaire administered to representatives from higher educational institutions where the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) was implemented in existing curricula for medical students, interns, and residents in family medicine and neurology, practicing physicians, and master’s program in mental health students. More than 700 students went through the programs that provided the feedback. Evaluations of program effectiveness mainly involved standard discipline tests or pre- and post-tests proposed in the mhGAP trainer manual. This finding suggested that mhGAP-IG can be successfully adapted and implemented both on undergraduate and on postgraduate education levels and among medical and nonmedical specialists. Future evaluations need to more definitively assess the clinical effectiveness of mhGAP-IG implementation.

Process evaluation of the ACTION programme: a strategy for implementing person‐centred communication in home care

Background There is currently a strong emphasis on person-centred care (PCC) and communication; however, little research has been conducted on how to implement person-centred communication in home care settings. Therefore, the ACTION (A person-centred CommunicaTION) programme, which is a web-based education programme focusing on person-centred communication developed for nurse assistants (NAs) providing home care for older persons, was implemented. This paper reports on the process evaluation conducted with the aim to describe and evaluate the implementation of the ACTION programme. Methods A descriptive design with a mixed method approach was used. Twenty-seven NAs from two units in Sweden were recruited, and 23 of them were offered the educational intervention. Quantitative and qualitative data were collected from multiple sources before, during and after the implementation. Quantitative data were used to analyse demographics, attendance and participation, while qualitative data were used to evaluate experiences of the implementation and contextual factors influencing the implementation. Results The evaluation showed a high degree of NA participation in the first five education modules, and a decrease in the three remaining modules. Overall, the NAs perceived the web format to be easy to use and appreciated the flexibility and accessibility. The content was described as important. Challenges included time constraints; the heavy workload; and a lack of interaction, space and equipment to complete the programme. Conclusions The results suggest that web-based education seems to be an appropriate strategy in home care settings; however, areas for improvement were identified. Our findings show that participants appreciated the web-based learning format in terms of accessibility and flexibility, as well as the face-to-face group discussions. The critical importance of organizational support and available resources are highlighted, such as management involvement and local facilitation. In addition, the findings report on the implementation challenges specific to the dynamic home care context. Trial registration This intervention was implemented with nursing assistants, and the evaluation only involved nursing staff. Patients were not part of this study. According to the ICMJE, registration was not necessary ().