Browsing by Author "De Silva, Mary"

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    Challenges and opportunities for implementing integrated mental health care : a district level situation analysis from five low- and middle-income countries
    (PLoS, 2014-02-18) Hanlon, Charlotte; Luitel, Nagendra P.; Kathree, Tasneem; Murhar, Vaibhav; Shrivasta, Sanjay; Medhin, Girmay; Ssebunnya, Joshua; Fekadu, Abebaw; Shidhaye, Rahul; Petersen, Inge; Jordans, Mark; Kigozi, Fred; Thornicroft, Graham; Patel, Vikram; Tomlinson, Mark; Lund, Crick; Breuer, Erica; De Silva, Mary; Prince, Martin
    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.
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    Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions : the Programme for Improving Mental Health Care (PRIME) cohort protocol
    (BioMed Central, 2018-03-06) Baron, Emily C.; Rathod, Sujit D.; Hanlon, Charlotte; Prince, Martin; Fedaku, Abebaw; Kigozi, Fred; Jordans, Mark; Luitel, Nagendra P.; Medhin, Girmay; Murhar, Vaibhav; Nakku, Juliet; Patel, Vikram; Petersen, Inge; Selohilwe, One; Shidhaye, Rahul; Ssebunnya, Joshua; Tomlinson, Mark; Lund, Crick; De Silva, Mary
    Background: The Programme for Improving Mental Health Care (PRIME) sought to implement mental health care plans (MHCP) for four priority mental disorders (depression, alcohol use disorder, psychosis and epilepsy) into routine primary care in five low- and middle-income country districts. The impact of the MHCPs on disability was evaluated through establishment of priority disorder treatment cohorts. This paper describes the methodology of these PRIME cohorts. Methods: One cohort for each disorder was recruited across some or all five districts: Sodo (Ethiopia), Sehore (India), Chitwan (Nepal), Dr. Kenneth Kaunda (South Africa) and Kamuli (Uganda), comprising 17 treatment cohorts in total (N = 2182). Participants were adults residing in the districts who were eligible to receive mental health treatment according to primary health care staff, trained by PRIME facilitators as per the district MHCP. Patients who screened positive for depression or AUD and who were not given a diagnosis by their clinicians (N = 709) were also recruited into comparison cohorts in Ethiopia, India, Nepal and South Africa. Caregivers of patients with epilepsy or psychosis were also recruited (N = 953), together with or on behalf of the person with a mental disorder, depending on the district. The target sample size was 200 (depression and AUD), or 150 (psychosis and epilepsy) patients initiating treatment in each recruiting district. Data collection activities were conducted by PRIME research teams. Participants completed follow-up assessments after 3 months (AUD and depression) or 6 months (psychosis and epilepsy), and after 12 months. Primary outcomes were impaired functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and symptom severity, assessed using the Patient Health Questionnaire (depression), the Alcohol Use Disorder Identification Test (AUD), and number of seizures (epilepsy). Discussion: Cohort recruitment was a function of the clinical detection rate by primary health care staff, and did not meet all planned targets. The cross-country methodology reflected the pragmatic nature of the PRIME cohorts: while the heterogeneity in methods of recruitment was a consequence of differences in health systems and MHCPs, the use of the WHODAS as primary outcome measure will allow for comparison of functioning recovery across sites and disorders.
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    Partnerships in a global mental health research programme — the example of PRIME
    (Springer, 2019) Breuer, Erica; Hanlon, Charlotte; Bhana, Arvin; Chisholm, Dan; De Silva, Mary; Fekadu, Abebaw; Honikman, Simone; Jordans, Mark; Kathree, Tasneem; Kigozi, Fred; Luitel, Nagendra P.; Marx, Maggie; Medhin, Girmay; Murhar, Vaibhav; Ndyanabangi, Sheila; Patel, Vikram; Petersen, Inge; Prince, Martin; Raja, Shoba; Rathod, Sujit D.; Shidhaye, Rahul; Ssebunnya, Joshua; Thornicroft, Graham; Tomlinson, Mark; Wolde-Giorgis, Tedla; Lund, Crick
    Collaborative research partnerships are necessary to answer key questions in global mental health, to share expertise, access funding and influence policy. However, partnerships between low- and middle-income countries (LMIC) and high-income countries have often been inequitable with the provision of technical knowledge flowing unilaterally from high to lower income countries. We present the experience of the Programme for Improving Mental Health Care (PRIME), a LMIC-led partnership which provides research evidence for the development, implementation and scaling up of integrated district mental healthcare plans in Ethiopia, India, Nepal, South Africa and Uganda. We use Tuckman’s first four stages of forming, storming, norming and performing to reflect on the history, formation and challenges of the PRIME Consortium. We show how this resulted in successful partnerships in relation to management, research, research uptake and capacity building and reflect on the key lessons for future partnerships.
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    PRIME : a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries
    (Public Library of Science, 2012-12-27) Lund, Crick; Tomlinson, Mark; De Silva, Mary; Fekadu, Abebaw; Shidhaye, Rahul; Jordans, Mark; Petersen, Inge; Bhana, Arvin; Kigozi, Fred; Prince, Martin; Thornicroft, Graham; Hanlon, Charlotte; Kakuma, Ritsuko; McDaid, David; Saxena, Shekhar; Chisholm, Dan; Raja, Shoba; Kippen-Wood, Sarah; Honikman, Simone; Fairall, Lara; Patel, Vikram
    The majority of people living with mental disorders in low- and middle-income countries do not receive the treatment that they need. There is an emerging evidence base for cost-effective interventions, but little is known about how these interventions can be delivered in routine primary and maternal health care settings.The aim of the Programme for Improving Mental Health Care (PRIME) is to generate evidence on the implementation and scaling up of integrated packages of care for priority mental disorders in primary and maternal health care contexts in Ethiopia, India, Nepal, South Africa, and Uganda.PRIME is working initially in one district or sub-district in each country, and integrating mental health into primary care at three levels of the health system: the health care organisation, the health facility, and the community.The programme is utilising the UK Medical Research Council complex interventions framework and the ‘‘theory of change’’ approach, incorporating a variety of qualitative and quantitative methods to evaluate the acceptability, feasibility, and impact of these packages.PRIME includes a strong emphasis on capacity building and the translation of research findings into policy and practice, with a view to reducing inequities and meeting the needs of vulnerable populations, particularly women and people living in poverty.