WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG): the first pre-service training study

BackgroundThere is a huge treatment gap for late-life depression in sub-Saharan Africa. Building on prior work to scale-up mental healthcare with the aid of the WHO Mental Health Gap Action Programme Intervention Guide electronic version (emhGAP-IG), this study aims to involve older people in the iterative development of innovations to overcome challenges in the detection and clinical management of late-life depression by frontline non-specialist primary healthcare workers (PHCW) in Nigeria.MethodologyThere were 43 participants in the study. We conducted formative qualitative research using 15 in-depth key informant interviews with persons who were 60 years or older and had a recent experience of depression. We also conducted two focus group discussions comprising 13 of their caregivers. Through a full day stakeholders workshop comprising 15 participants, we drew on the results of our qualitative explorations to identify the pathway to impact of an intervention package (emhGAP-Age) appropriate for the specific needs of persons with late-life depression in Nigeria.ResultsA Theory of Change (ToC) map was produced. It highlights the expected long-term outcomes of emhGAP-Age to include the potential for improvement of the mental health and wellbeing of older people living in Nigeria and the generation of interest among governmental agencies concerned with policy and planning for mental healthcare. Key resources that serve as preconditions were identified to consist of the availability of PHCW who are skilled in the identification and treatment of depression and have interest in and commitment to providing care to older people. Required community resources include support from immediate family, neighbours, and informal groups. Interventions that are appropriate for depression in old age need to incorporate these community resources and address not only the symptoms of the condition but also comorbid physical health problems.ConclusionA participatory ToC process led to the identification of the key components of an age-appropriate version of the emhGAP-IG for delivering care to older persons with depression by PHCW in Nigeria.

There is currently a high global demand for mental health professionals, including child and adolescent mental health professionals. In 2020, the World Health Organization (WHO) published “Enhancing mental health pre-service training with the mhGAP-Intervention Guide: experiences and lessons learned” to address the proposition of implementing Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) materials and principles as a component of pre-service training. By integrating the mhGAP-IG within pre-service training, future healthcare providers will acquire theoretical knowledge and early exposure to practical knowledge and will be better prepared for their future work.Examples demonstrate that mhGAP-IG pre-service training can be successfully implemented in diverse settings and in various pre-service training programs. It can be used in small group learning activities and short courses, taught through lectures, used as a clinical tool to teach students (i.e. medical, nursing students) and medical doctors in training. We can enhance pre-service training with the mhGAP-IG and contribute to a learning environment, which nurtures knowledge and skills required to help people with mental health needs.

Task sharing: stopgap or end goal?

This paper reports on the training of primary care physicians in the family medicine programme at the University of Gezira, Sudan, using the World Health Organization’s Mental Health Gap Action Programme Intervention Guide (mhGAP-IG). The training had a positive impact on their knowledge of and attitudes to mental disorder. More field tests of the mhGAP-IG would be useful to make further recommendations on its cultural relevance and its adaptation for use in low- and middle-income countries. Distance supervision of training of primary care physicians by internal facilitators is seen as critical for the sustainability of the intervention.

BackgroundThe Mental Health Gap Action Programme (mhGAP) supports engagement of non-specialists in mental health services in Low- and Middle-Income countries. Given this aim, assessment of the effectiveness of approaches under its remit is warranted.AimsWe evaluated mhGAP approaches relating to child and adolescent mental health, focusing on provider / child outcomes, and barriers / facilitators of implementation.MethodsThirteen databases were searched for reviews and primary research on mhGAP roll out for child and adolescent mental health.ResultsTwelve studies were reviewed. Provider-level outcomes were restricted to knowledge gains, with limited evidence of other effects. Child-level outcomes included improved access to care, enhanced functioning and socio-emotional well-being. Organisational factors, clients and providers? attitudes and expectations, and transcultural considerations were barriers.ConclusionsFurther attention to the practical and methodological aspects of implementation of evaluation may improve the quality of evidence of the effectiveness of approaches under its remit.

IntroductionDespite carrying a disproportionately high burden of depression, patients in low-income countries lack access to effective care. The collaborative care model (CoCM) has robust evidence for clinical effectiveness in improving...

BackgroundThere is a shortage of trained mental health workers in spite of the significant contribution of psychiatric disorders to the global disease burden. Task shifting, through the delegation of health care tasks to less specialised health workers such as community health workers (CHWs), is a promising approach to address the human resource shortage. CHWs in the Western Cape province of South Africa provide comprehensive chronic support which includes that for mental illness, but have thus far not received standardized mental health training. It is unknown whether a structured mental health training programme would be acceptable and feasible, and result improved knowledge, confidence and attitudes amongst CHWs.MethodsWe developed and piloted a mental health training programme for CHWs, in line with the UNESCO guidelines; the WHO Mental Health Gap Action Programme and the South African National framework for CHW training. In our quasi-experimental (before-after) cohort intervention study we measured outcomes at the start and end of training included: 1) Mental health knowledge, measured through the use of case vignettes and the Mental Health Knowledge Schedule; 2) confidence, measured with the Mental Health Nurse Clinical Confidence Scale; and 3) attitudes, measured with the Community Attitudes towards the Mentally Ill Scale. Knowledge measures were repeated 3 months later. Acceptability data were obtained from daily evaluation questionnaires and a training evaluation questionnaire, while feasibility was measured by participant attendance at training sessions.ResultsFifty-eight CHWs received the training, with most (n = 56, 97.0%) attending at least 7 of the 8 sessions. Most participants (n = 29, 63.04%) demonstrated significant improvement in knowledge, which was sustained at 3-months. There was significant improvement in confidence, along with changes in attitude, indicating improved benevolence, reduced social restrictiveness, and increased tolerance to rehabilitation of the mentally ill in the community but there was no change in authoritarian attitudes. The training was acceptable and feasible.ConclusionsMental health training was successful in improving knowledge, confidence and attitudes amongst trained CHWs. The training was acceptable and feasible. Further controlled studies are required to evaluate the impact of such training on patient health outcomes.Trial registrationPACTR PACTR201610001834198, Registered 26 October 2016.

Objective Mental disorders are a challenge among Internally Displaced People (IDPs). Training lay mental health workers (LMHWs) might offer an effective solution. Method The study was conducted in a camp for IDPs in Malakal, South Sudan. LMHWs were trained based on WHO Mental Health Gap Action Programme (mh-GAP) guidelines to provide psychosocial interventions. Participants (n = 988) were randomised to either the intervention arm, receiving help from the trained lay mental health workers (LMHWs), or a waitlist control arm. A structured clinical interview, the Composite International Diagnostic Interview (CIDI), as well as the Brief Disability Questionnaire (BDQ), Impact Event Scale (IES) and the Alcohol Use Disorders Identification Test (AUDIT) were used for baseline and follow-up assessment. Results A statistically significant intervention effect on PTSD severity was established (Cohen’s d = −0.20, 95% CI = (−0.23, −0.17), p < 0.001). Additionally, significant effects on the prevalence of several CIDI diagnoses, including anxiety and depression (OR = 0.46, 95% CI = (0.33, 0.63) and OR = 0.62, 95% CI = (0.45, 0.84), respectively) were found. Disability and alcohol abuse were also reduced (Cohen’s d = −0.30, 95% CI = (−0.38, −0.21) and d = −0.08, 95% CI = (−0.13, −0.02), respectively). The positive impact of treatment was found to be lower in the control group. Discussion The lessons learned could potentially be used future programs.

Background: There exists a wide treatment gap for mental health problems in children and adolescents in Nigeria. Reducing the treatment gap and improving the reach of mental health care thus call for additional interventions such as harnessing teachers as well as other educational staff as a task-sharing strategy. This study thus aimed to determine the effectiveness of online-based training on the knowledge of selected childhood mental health disorders among teachers in Kaduna, North-Western Nigeria. Methods: A quasi-experimental study design was used and involved 50 teachers from 12 private and 12 public primary and secondary schools in Kaduna, Kaduna state. Participants were trained through the Zoom online medium, and training ran for three days in 2 sessions of morning and afternoon sessions per day. Each session lasted for 2 hours including time for questions with 2 hours break between sessions. Learning sessions were adapted from the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG).Other materials that were not in the mhGAP-IG such as Covid-19 and its impact on child mental health were designed from current, evidence-based reference texts. For the outcome measures, questionnaires on the level of knowledge were administered to participants at pre-training and post-training. Data were analysed with the Statistical Package for Social Sciences (SPSS) Version 25. Results: Participants had an overall percentage score of 70.24% on the “Correct” responses, 8% on the “Don’t Know” responses, and 17.76% on the “Incorrect” responses before the training. The online training demonstrated an increase in the overall percentage score on the “Correct Responses” to 79.76%; a decrease in the “Don’t Know Responses” to 1% and the “Incorrect Responses” to 15.24%. There was also an improvement in the mean scores of participants on each module covered. Conclusion: The online teacher training demonstrated an increase in the knowledge of participants, and a decrease in the misperceptions and lack of knowledge which is consistent with findings from other parts of the world.

Determining the Optimum Spherical Aberration Correction of the Low Myopic Human Eye With Contact Lenses

Psychological interventions that are brief, acceptable, effective and can be delivered by non-specialists are especially necessary in low- and middle-income countries, where mental health systems are unable to address the high level of psychosocial needs. Problem Management Plus (PM+) is a five-session intervention designed for those impaired by psychological distress while living in communities affected by adversity. Individual PM+ has demonstrated effectiveness in reducing distress in Kenya and Pakistan, and a group version of PM+ (Group PM+) was effective for conflict-affected women in Pakistan. This paper describes a feasibility and acceptability trial of locally adapted Group PM+ for women and men in an earthquake-affected region of rural Nepal. In this feasibility cluster randomised controlled trial, participants in the experimental arm were offered five sessions of Group PM+ and participants in the control arm received enhanced usual care (EUC), which entailed brief psycho-education and providing referral options to primary care services with health workers trained in the mental health Gap Action Programme Intervention Guide (mhGAP-IG). A mixed-methods design was used to assess the feasibility and acceptability of Group PM+. Feasibility was assessed with criteria including fidelity and retention of participants. Acceptability was assessed through in-depth interviews with participants, family members, programme staff and other stakeholders. The primary clinical outcome was depression symptoms assessed using the Patient Health Questionnaire (PHQ-9) administered at baseline and 8-8.5 weeks post-baseline (i.e. after completion of Group PM+ or EUC). We recruited 121 participants (83% women and 17% men), with equal allocation to the Group PM+ and EUC arms (1:1). Group PM+ was delivered over five 2.5-3 hour sessions by trained and supervised gender-matched local non-specialists, with an average attendance of four out of five sessions. The quantitative and qualitative results demonstrated feasibility and acceptability for non-specialists to deliver Group PM+. Though the study was not powered to assess for effectiveness, for all five key outcome measures, including the primary clinical outcome, the estimated mean improvement was larger in the Group PM+ arm than the EUC arm. The intervention and trial procedures were acceptable to participants, family members, and programme staff. The communities and participants found the intervention to be beneficial. Because feasibility and acceptability were established in this trial, a fully powered randomised controlled trial will be conducted for larger scale implementation to determine the effectiveness of the intervention in Nepal.

Global mental health and HIV care: gaps and research priorities.

The global evidence base for interventions to alleviate mental, neurological and substance use (MNS) disorders is increasingly robust. In this chapter we review the principles of effectiveness, feasibility, equity, acceptability and affordability that should underpin any intervention for MNS disorders and argue for an evidence-based approach. The recent World Health Organization’s mental health Gap Action Programme Intervention Guidelines are considered in depth, both with respect to the process of guideline development and the nature of the evidence-based recommendations. Future directions are outlined, including the need to develop more effective interventions that are contextually appropriate, and focusing on how to implement packages of interventions in practice.

To identify implementation variables and justify the use of the community component of the Mental Health Gap Action Programme (mhGAP). The search was carried out in Cochrane, PubMed, Emerald, Scopus, Scielo, Redalyc and Google Scholar databases. Studies that analyzed the implementation of the community component of mhGAP were included, excluding those focused solely on the clinical component of mhGAP. Out of the 726 records initially identified, only four met the inclusion criteria. The findings reveal that the evaluation of the community component of mhGAP has primarily been conducted in conjunction with other global and community mental health strategies, as part of multimodal approaches. Factors are recognized as key barriers and facilitators for the successful implementation of the program. The community component of mhGAP presents itself as a promising proposal to strengthen community-based mental health strategies. However, there is an urgent need to generate more evidence on the implementation of these strategies, particularly in terms of resource availability, long-term sustainability, and outcome monitoring.

The World Health Organization's (WHOs) Mental Health Gap Action Programme (mhGAP) aims to improve healthcare for mental, neurological, and substance use disorders in nonspecialized settings, with a focus on low- and middle-income countries (LMICs). mhGAP includes guidelines for the treatment of psychoses (including schizophrenia), which were recently updated in 2023. The complexity of the WHO guideline update process and the updated recommendations on psychoses are presented. The WHO guideline development process is outlined as well as the evidence appraisal and the translation of the evidence into recommendations following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The guideline update process includes a review of the literature, a compilation of systematic reviews, and extracting data related to critical and important outcomes. The updated recommendations and the justifying evidence are discussed. The WHO mhGAP guidelines for psychoses are adapted to LMICs, and consist of 13 recommendations in 2023, whereof 5 were updated, and 1 recommendation was newly developed. Background information on how these recommendations were obtained, and significant changes since the previous guideline update in 2015 are provided. Unlike other guidelines, the WHO must consider various countries, contextual factors, and the WHO Model Lists of Essential Medicines when developing its guidelines. A transformation of the WHO guideline for psychoses into a living guideline would ensure always up-to-date recommendations and facilitate shared decision-making.