@article{c305be61e74044fb9d10a763887c5f11,
title = "Scaling up integrated primary mental health in six low- and middle-income countries: obstacles, synergies and implications for systems reform",
abstract = "BackgroundThere 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).AimsTo investigate systems-level implications of efforts to scale-up integrated mental healthcare into PHC in districts in six LMICs.MethodSemi-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.ResultsEnsuring that interventions are synergistic with existing health system features and strengthening of the healthcare system building blocks to support integrated chronic care and tasksharing 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.ConclusionsScaling 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.",
keywords = "CARE, Mental health services, global mental health, integrated care, low-and middle-income countries, primary healthcare",
author = "Inge Petersen and {van Rensburg}, Andre and Fred Kigozi and Maya Semrau and Charlotte Hanlon and Jibnl Abdulmalik and Lola Kola and Abebaw Fekadu and Oye Gureje and Dristy Gurung and Mark Jordans and Ntokozo Mntambo and James Mugisha and Shital Muke and Ruwayda Petrus and Rahul Shidhaye and Joshua Ssebunnya and Bethlehem Tekola and Nawaraj Upadhaya and Vikram Patel and Crick Lund and Graham Thornicroft",
note = "Funding Information: The research leading to these results is funded by the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement number 305968. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. It is also an output of the PRogramme for Improving Mental health carE (PRIME) supported by the UK Department for International Development (201446). The views expressed do not necessarily reflect the UK Government's official policies. The funder did not have any involvement in the study design, collection, analysis or interpretation of data or writing of the manuscript. G.T. is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London and by the NIHR Applied Research Centre (ARC) at King's College London NHS Foundation Trust, and the NIHR Applied Research and the NIHR Asset Global Health Unit award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. G.T. receives support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470 (Cobalt study). G.T. is supported by the UK Medical Research Council in relation the Emilia (MR/ S001255/1) and Indigo Partnership (MR/R023697/1) awards. I.P. and G.T. also receive support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470. I.P., A.v.R., C.H. and C.L. are funded by the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King's College London (GHRU 16/136/54) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. C.H. additionally receives support from AMARI as part of the DELTAS Africa Initiative (DEL-15-01). Funding Information: The research leading to these results is funded by the European Union's Seventh Framework Programme (FP7/2007–2013) under grant agreement number 305968. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. It is also an output of the PRogramme for Improving Mental health carE (PRIME) supported by the UK Department for International Development (201446). The views expressed do not necessarily reflect the UK Government's official policies. The funder did not have any involvement in the study design, collection, analysis or interpretation of data or writing of the manuscript. G.T. is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London and by the NIHR Applied Research Centre (ARC) at King{\textquoteright}s College London NHS Foundation Trust, and the NIHR Applied Research and the NIHR Asset Global Health Unit award. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. G.T. receives support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470 (Cobalt study). G.T. is supported by the UK Medical Research Council in relation the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. I.P. and G.T. also receive support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470. I.P., A.v.R., C.H. and C.L. are funded by the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa, King{\textquoteright}s College London (GHRU 16/136/54) using UK aid from the UK Government. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. C.H. additionally receives support from AMARI as part of the DELTAS Africa Initiative (DEL-15-01). Acknowledgements Publisher Copyright: Copyright {\textcopyright} The Royal College of Psychiatrists 2019.",
year = "2019",
month = aug,
day = "6",
doi = "10.1192/bjo.2019.7",
language = "English",
volume = "5",
pages = "1--8",
journal = "Bjpsych open",
issn = "2056-4724",
publisher = "Cambridge University Press",
number = "5",
}