Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries

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dc.contributor.authorHanlon, Charlotteen_ZA
dc.contributor.authorLuitel, Nagendra Pen_ZA
dc.contributor.authorKathree, Tasneemen_ZA
dc.contributor.authorMurhar, Vaibhaven_ZA
dc.contributor.authorShrivasta, Sanjayen_ZA
dc.contributor.authorMedhin, Girmayen_ZA
dc.contributor.authorSsebunnya, Joshuaen_ZA
dc.contributor.authorFekadu, Abebawen_ZA
dc.contributor.authorShidhaye, Rahulen_ZA
dc.contributor.authorPetersen, Ingeen_ZA
dc.date.accessioned2015-11-16T04:07:21Z
dc.date.available2015-11-16T04:07:21Z
dc.date.issued2014en_ZA
dc.description.abstractBACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care.en_ZA
dc.identifier.apacitationHanlon, C., Luitel, N. P., Kathree, T., Murhar, V., Shrivasta, S., Medhin, G., ... Petersen, I. (2014). Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries. <i>PLoS One</i>, http://hdl.handle.net/11427/14980en_ZA
dc.identifier.chicagocitationHanlon, Charlotte, Nagendra P Luitel, Tasneem Kathree, Vaibhav Murhar, Sanjay Shrivasta, Girmay Medhin, Joshua Ssebunnya, Abebaw Fekadu, Rahul Shidhaye, and Inge Petersen "Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/14980en_ZA
dc.identifier.citationHanlon, C., Luitel, N. P., Kathree, T., Murhar, V., Shrivasta, S., Medhin, G., ... & Prince, M. (2014). Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries. PloS one, 9(2), e88437. doi:10.1371/journal.pone.0088437en_ZA
dc.identifier.ris TY - Journal Article AU - Hanlon, Charlotte AU - Luitel, Nagendra P AU - Kathree, Tasneem AU - Murhar, Vaibhav AU - Shrivasta, Sanjay AU - Medhin, Girmay AU - Ssebunnya, Joshua AU - Fekadu, Abebaw AU - Shidhaye, Rahul AU - Petersen, Inge AB - BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0088437 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries TI - Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries UR - http://hdl.handle.net/11427/14980 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14980
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0088437
dc.identifier.vancouvercitationHanlon C, Luitel NP, Kathree T, Murhar V, Shrivasta S, Medhin G, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countries. PLoS One. 2014; http://hdl.handle.net/11427/14980.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentCentre for Public Mental Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2014 Hanlon et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherMental health and psychiatryen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherEthiopiaen_ZA
dc.subject.otherNepalen_ZA
dc.subject.otherHealth services researchen_ZA
dc.subject.otherUgandaen_ZA
dc.subject.otherIndiaen_ZA
dc.subject.otherHIVen_ZA
dc.titleChallenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low-and middle-income countriesen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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