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Little is known about the service and system interventions required for successful integration of mental healthcare into primary care across diverse low- and middle-income countries (LMIC).
To examine the commonalities, variations and evidence gaps in district-level mental healthcare plans (MHCPs) developed in Ethiopia, India, Nepal, Uganda and South Africa for the PRogramme for Improving Mental health carE (PRIME).
A comparative analysis of MHCP components and human resource requirements.
A core set of MHCP goals was seen across all countries. The MHCPs components to achieve those goals varied, with most similarity in countries within the same resource bracket (low income v. middle income). Human resources for advanced psychosocial interventions were only available in the existing health service in the best-resourced PRIME country.
Application of a standardised methodological approach to MHCP across five LMIC allowed identification of core and site-specific interventions needed for implementation.
The management and treatment of mental disorders in primary care is a fundamental step which enables the largest number of people to get easier and faster access to services. Primary health care systems are increasingly relied upon to deliver a myriad of health services, especially in situations of scarcity. In low- and middle- income countries, where poverty and sickness are high, and access to health care is low, health professionals and policy makers have emphasized approaches that integrate the diverse roles of health care and social systems. For HIV programs, integration has enabled shared use of space and staffing through training of healthcare workers and standardizing procedures, increasing the number of people who have receive care. Integration to primary care was one of the World Health Organization's (WHO's) 10 recommendations in the World Health Report 2001 on mental health.
The prevention, care, and rehabilitation of mental disorders are a growing public health problem globally. Addressing the increasing public health burden of mental disorders worldwide requires an understanding of the prevalence, associated disability, and treatment gap associated with these disorders. Community-based psychiatric epidemiological studies provide insights into the magnitude of the burden. Estimates of the prevalence of specific mental disorders in numerous countries globally have been established using either structured or semi-structured interview schedules linked to current diagnostic criteria that have improved the reliability and validity of psychiatric diagnoses. The World Mental Health (WMH) surveys and the International Consortium of Psychiatric Epidemiology are cross-national initiatives that have demonstrated that mental disorders are highly prevalent throughout the world. Neuropsychiatric conditions account for a disproportionate amount of burden of disease, although they result in few direct deaths.
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