Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-08T09:17:42.121Z Has data issue: false hasContentIssue false

Development and pilot testing of a mental healthcare plan in Nepal

Published online by Cambridge University Press:  02 January 2018

M. J. D. Jordans
Affiliation:
Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands and Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
N. P. Luitel
Affiliation:
Research Department, Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
P. Pokhrel
Affiliation:
Research Department, Transcultural Psychosocial Organization (TPO), Kathmandu, Nepal
V. Patel
Affiliation:
Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London and Sangath Centre, Goa, India
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background

Mental health service delivery models that are grounded in the local context are needed to address the substantial treatment gap in low- and middle-income countries.

Aims

To present the development, and content, of a mental healthcare plan (MHCP) in Nepal and assess initial feasibility.

Method

A mixed methods formative study was conducted. Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from patients (n = 135) during the pilot-testing phase in two health facilities.

Results

The resulting MHCP consists of 12 packages, divided over community, health facility and organisation platforms. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers and high drop-out rates.

Conclusions

The MHCP follows a collaborative care model encompassing community and primary healthcare interventions.

Type
Papers
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
Copyright
Copyright © Royal College of Psychiatrists, 2016

Footnotes

This document is an output from the PRIME Research Programme Consortium, funded by the UK Department of International Development (DFID) for the benefit of low- and middle-income countries. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. The authors had full control of all primary data.

Declaration of interest

None.

References

1 Patel, V, Saxena, S. Transforming lives, enhancing communities: innovations in global mental health. N Engl J Med 2014; 370: 498501.CrossRefGoogle ScholarPubMed
2 Lancet Mental Health Group. Scale up services for mental disorders: a call for action. Lancet 2007; 370: 1241–52.Google Scholar
3 Demyttenaere, K, Bruffaerts, R, Posada-Villa, J, Gasquet, I, Kovess, V, Lepine, JP, et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004; 291: 2581–90.Google Scholar
4 World Health Organization. mhGAP Intervention Guide for Mental, Neurological And Substance Use Disorders in Non-Specialized Health Settings. WHO, 2010.Google Scholar
5 Hanlon, 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; 9: e88437.Google Scholar
6 Ventevogel, P, Perez-Sales, P, Fernandez-Liria, A, Baingana, F. Integrating mental health care into existing systems of health care: during and after complex humanitarian emergencies. Intervention 2011; 9: 195210.Google Scholar
7 Raja, S, Underhill, C, Shrestha, P, Sunder, U, Mannarath, S, Wood, SK, et al. Integrating mental health and development: a case study of the basic needs model in Nepal. PLoS Med 2012; 9: e1001261.CrossRefGoogle Scholar
8 Acland, S. Mental health services in primary care. In World Mental Health Casebook: Social and Mental Programs in Low-Income Countries (eds Cohen, CA, Kleinman, A, Saraceno, B): 121–52. Springer, 2002.Google Scholar
9 Jordans, MJD, Keen, AS, Pradhan, H, Tol, WA. Psychosocial counseling in Nepal: perspectives of counselors and beneficiaries. Int J Adv Couns 2007; 29: 5768.Google Scholar
10 Lund, C, Tomlinson, M, De Silva, M, Fekadu, A, Shidhaye, R, Jordans, M, et al. PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 2012; 9: e1001359.Google Scholar
11 Thapa, D, Sijapati, B. A Kingdom Under Siege: Nepal's Maoist Insurgency, 1996 to 2003 (updated edn). The Printhouse, 2004.Google Scholar
12 Central Bureau of Statistics. Population Monograph of Nepal (Vol. 1). CBS, 2003 (http://cbs.gov.np/?p=318).Google Scholar
13 Petersen, I, Fairall, L, Bhana, A, Kathree, T, Selohilwe, O, Brooke-Sumner, C, et al. Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153726).CrossRefGoogle Scholar
14 Jordans, MJD, Luitel, NP, Tomlinson, M, Komproe, IH. Setting priorities for mental health care in Nepal: a formative study. BMC Psychiatry 2013; 13: 332.CrossRefGoogle Scholar
15 Attkisson, CC, Zwick, R. The Client Satisfaction Questionnaire: psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann 1982; 5: 233–7.CrossRefGoogle ScholarPubMed
16 Lacey, A, Luff, D. Qualitative Data Analysis. Trent Focus, 2001.Google Scholar
17 World Medical Association. Declaration of Helsinki: recommendations guiding physicians in biomedical research involving human subjects. JAMA 1997; 277: 925–6.Google Scholar
18 Anand, A, Chowdhary, N, Dimidjian, S and Patel, V. Healthy Activity Program (HAP). Sangath, 2014.Google Scholar
19 Dabholkar, H, Nadkarni, A, Velleman, RDB, Patel, V. Counselling for Alcohol Problems (CAP). Sangath, 2014.Google Scholar
20 Rahman, A, Malik, A, Sikander, S, Roberts, C, Creed, F. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 2008; 372: 902–9.Google Scholar
21 Jordans, MJD, Kohrt, BA, Luitel, NP, Komproe, IH, Lund, C. Accuracy of proactive case finding for mental disorders by community informants in Nepal. Br J Psychiatry, in press (doi: 10.1192/bjp.bp.113.141077).Google Scholar
22 Baingana, F, Onyango Mangen, P. Scaling up of mental health and trauma support among war-affected communities in northern Uganda: lessons learned. Intervention 2011; 9: 291303.Google Scholar
23 Goncalves, DA, Fortes, S, Campos, M, Ballester, D, Portugal, FB, Tófoli, LF, et al. Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre-and posttest study. Gen Hosp Psychiatry 2013; 35: 304–8.CrossRefGoogle Scholar
24 Kohrt, BA, Jordans, MJD, Rai, S, Shrestha, P, Luitel, NP, Ramaiya, M, et al. Therapist competence in global mental health: development of the Enhancing Assessment of Common Therapeutic Factors (ENACT) Rating Scale. Behav Res Ther 2015; 69: 1121.Google Scholar
25 Jordans, MJD, Tol, WA. Mental health in humanitarian settings: shifting focus to care systems. Int Health 2013; 5: 910.Google Scholar
26 Ventevogel, P, Ndayisaba, H, Van de Put, W. Psychosocial assistance and decentralized mental health care in post conflict Burundi. Intervention 2011; 9: 315–32.Google Scholar
27 Kohan, I, Perez-Sales, P, Cisneros, MH, Chirinos, R, Perez-Langa, R, Holguin, MR. Emergencies and disasters as opportunities to improve mental health systems: Peruvian experience in Huancavelica. Intervention 2011; 9: 237–48.Google Scholar
28 Belfer, ML, Remschmidt, H, Nurcombe, B, Okasha, A, Sartorius, N. A global programme for child and adolescent mental health: a challenge in the new millennium. In The Mental Health of Children and Adolescents: An Area of Global Neglect (eds Remschmidt, H, Nurcombe, B, Belfer, M, Sartorius, N, Okasha, A). John Wiley & Sons, 2007.Google Scholar
29 Holcomb, WR, Parker, JC, Leong, GB, Thiele, J, Higdon, J. Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients. Psychiatr Serv 1998; 49: 929–35.Google Scholar
30 Carlson, MJ, Gabriel, RM. Patient satisfaction, use of services, and one-year outcomes in publicly funded substance abuse treatment. Psychiatr Serv 2001; 52: 1230–6.Google Scholar
31 Cohen, A, Eaton, J, Radtke, B, George, C, Manual, BV, De Silva, M, et al. Three models of community mental health services in low-income countries. Int J Ment Health Syst 2011; 5: 110.Google Scholar
32 Hanlon, C, Fekadu, A, Jordans, M, Kigozí, F, Petersen, I, Shidhaye, R, et al. District mental health care plans for five low- and middle-income countries: commonalities, variations and evidence gaps. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153858).Google Scholar
33 Becker, AE, Kleinman, A. Mental health and the global agenda. N Engl J Med 2013; 369: 6673.Google Scholar
34 Thornicroft, G, Tansella, M. The balanced care model for global mental health. Psychol Med 2012; 43: 849–63.Google Scholar
35 De Silva, MJ, Rathod, SD, Hanlon, C, Breuer, E, Chisholm, D, Fekadu, A, et al. Evaluation of district mental healthcare plans: the PRIME consortium methodology. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153858).CrossRefGoogle Scholar
36 Chisholm, D, Burman-Roy, S, Fekadu, A, Kathree, T, Kizza, D, Luitel, NP, et al. Estimating the cost of implementing district mental healthcare plans in five low- and middle-income countries: the PRIME study. Br J Psychiatry 2015, in press (doi: 10.1192/bjp.bp.114.153866).Google Scholar
Supplementary material: PDF

Jordans et al. supplementary material

Supplementary Figure S1-S3

Download Jordans et al. supplementary material(PDF)
PDF 294.3 KB
Submit a response

eLetters

No eLetters have been published for this article.