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 P.en_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.contributor.authorJordans, Marken_ZA
dc.contributor.authorKigozi, Freden_ZA
dc.contributor.authorThornicroft, Grahamen_ZA
dc.contributor.authorPatel, Vikramen_ZA
dc.contributor.authorTomlinson, Marken_ZA
dc.contributor.authorLund, Cricken_ZA
dc.contributor.authorBreuer, Ericaen_ZA
dc.contributor.authorDe Silva, Maryen_ZA
dc.contributor.authorPrince, Martinen_ZA
dc.date.accessioned2016-03-09T08:54:26Z
dc.date.available2016-03-09T08:54:26Z
dc.date.issued2014-02-18
dc.descriptionCITATION: Hanlon, C. et al. 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.0088437.
dc.descriptionThe original publication is available at http://journals.plos.org/plosone
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.description.urihttp://journals.plos.org/plosone/article?id=10.1371/journal.pone.0088437
dc.description.versionPublisher's versionaf_ZA
dc.format.extent12 pagesen_ZA
dc.identifier.citationHanlon, C. et al. 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.0088437.
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0088437
dc.identifier.urihttp://hdl.handle.net/10019.1/98268
dc.language.isoen_ZAen_ZA
dc.publisherPLoS
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectMental health careen_ZA
dc.subjectMental health services -- Africaen_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.typeArticleen_ZA
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