TY - JOUR
KW - Mental Health Services
KW - global mental health
KW - integrated care
KW - low -and middle-income countries
KW - primary healthcare
AU - I. Petersen
AU - A. van Rensburg
AU - F. Kigozi
AU - M. Semrau
AU - C. Hanlon
AU - J. Abdulmalik
AU - L. Kola
AU - A. Fekadu
AU - O. Gureje
AU - D. Gurung
AU - M. Jordans
AU - N. Mntambo
AU - J. Mugisha
AU - S. Muke
AU - R. Petrus
AU - R. Shidhaye
AU - J. Ssebunnya
AU - B. Tekola
AU - N. Upadhaya
AU - V. Patel
AU - C. Lund
AU - G. Thornicroft
A1 - 
AB - BACKGROUND: There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs). AIMS: To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs. METHOD: Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks. RESULTS: Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation. CONCLUSIONS: Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important. DECLARATION OF INTEREST: None.
AD - Research Professor and Director, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa.; Senior Researcher, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa.; Senior Consultant Psychiatrist/Researcher, Butabika National Referral and Teaching Mental Hospital, Uganda.; Research Fellow, Centre for Global Mental Health, Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and Global Health and Infection Department, Brighton and Sussex Medical School, UK.; Adjunct Associate Professor, Department of Psychiatry, Addis Ababa University, Ethiopia; and Reader in Global Mental Health, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.; Senior Lecturer, Department of Psychiatry, University of Ibadan, Nigeria.; Researcher, Department of Psychiatry, University of Ibadan, Nigeria.; Professor in Global Mental Health, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia; and Global Health & Infection Department, Brighton and Sussex Medical School, UK.; Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa.; Research Coordinator, Transcultural Psychosocial Organisation, Nepal.; Reader, Center for Global Mental Health, King's College London, UK.; Researcher, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa.; Senior Lecturer, Department of Sociology, Kyambogo University and Butabika National Referral an(TRUNCATED)
BT - BJPsych open
C5 - Education & Workforce
CP - 5
CY - England
DO - 10.1192/bjo.2019.7
IS - 5
JF - BJPsych open
LA - eng
M1 - Journal Article
N2 - BACKGROUND: There is a global drive to improve access to mental healthcare by scaling up integrated mental health into primary healthcare (PHC) systems in low- and middle-income countries (LMICs). AIMS: To investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs. METHOD: Semi-structured interviews were conducted with 121 managers and service providers. Transcribed interviews were analysed using framework analysis guided by the Consolidated Framework for Implementation Research and World Health Organization basic building blocks. RESULTS: Ensuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and task-sharing were identified as aiding integration efforts. The latter includes (a) strengthening governance to include technical support for integration efforts as well as multisectoral collaborations; (b) ring-fencing mental health budgets at district level; (c) a critical mass of mental health specialists to support task-sharing; (d) including key mental health indicators in the health information system; (e) psychotropic medication included on free essential drug lists and (f) enabling collaborative and community- oriented PHC-service delivery platforms and continuous quality improvement to aid service delivery challenges in implementation. CONCLUSIONS: Scaling up integrated mental healthcare in PHC in LMICs is more complex than training general healthcare providers. Leveraging existing health system processes that are synergistic with chronic care services and strengthening healthcare system building blocks to provide a more enabling context for integration are important. DECLARATION OF INTEREST: None.
PP - England
PY - 2019
SN - 2056-4724; 2056-4724
T1 - Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform
T2 - BJPsych open
TI - Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform
U1 - Education & Workforce
U2 - 31530322
U3 - 10.1192/bjo.2019.7
VL - 5
VO - 2056-4724; 2056-4724
Y1 - 2019
Y2 - Aug 6
ER -