{"id":1890,"date":"2019-10-09T11:06:49","date_gmt":"2019-10-09T10:06:49","guid":{"rendered":"http:\/\/blogs.lshtm.ac.uk\/hppdebated\/?p=1890"},"modified":"2019-12-03T18:01:09","modified_gmt":"2019-12-03T18:01:09","slug":"celebrating-commitment-to-mental-health-care-in-primary-health-care-settings","status":"publish","type":"post","link":"https:\/\/blogs.lshtm.ac.uk\/hppdebated\/2019\/10\/09\/celebrating-commitment-to-mental-health-care-in-primary-health-care-settings\/","title":{"rendered":"Celebrating commitment to mental health care in primary health care settings"},"content":{"rendered":"

By Jessica Spagnolo (School of Public Health, IRSPUM, Universit\u00e9 de Montr\u00e9al)<\/strong><\/p>\n

Global mental health aims to increase access to mental health care and to encourage the social inclusion of people living with mental ill health by promoting services as close as possible to people\u2019s communities. This view also aligns with the Declaration of Alma-Ata<\/a>, an affirmation in advancing the health of all people including those living with mental health disorders. In October 2018, the global community gathered at the Global Conference on Primary Health Care<\/a> to renew its commitment to building strong primary health care systems by celebrating the 40th<\/sup> anniversary of the Declaration of Alma-Ata and the launch of the Astana Declaration<\/a>. Global leaders present at the conference committed to strengthening health systems by further investing in the infrastructure and workforce within primary health care in order to provide proximity health and mental health services.<\/p>\n

Almost one year later, on this 2019 World Mental Health Day<\/a>, we are still discussing and reinforcing efforts to improve access to mental health services worldwide, for example, via primary health care settings. Primary health care is an important setting in global mental health. First, it is a promising way to increase access to needed, timely, comprehensive, and effective mental health services that are affordable. Second, given the association between mental health disorders and communicable and non-communicable diseases, vertical (stand-alone) programs traditionally favoured in the mental health field are not as effective as integrated approaches. Last, with the strategic position of primary healthcare providers in many primary health care settings around the globe, the World Health Organization (WHO) has recognized mental health as a core component of their training.<\/p>\n

In line with such evidence and international momentum, our research team (i.e., a collaboration between the School of Public Health at Universit\u00e9 de Montr\u00e9al, members of the Ministry of Health in Tunisia, the WHO office in Tunisia, and the Montreal WHO-PAHO Collaborating Center for Research and Training in Mental Health) offered a training based on the Mental Health Gap Action Program (mhGAP) Intervention Guide (IG) (version 1.0)<\/a> and developed by the WHO to primary care physicians working in the Greater Tunis area of Tunisia. They were trained in effective ways to detect, diagnose, and treat depression, psychosis, self-harm\/suicide, and substance use disorders.<\/a> We used an exploratory trial (which included a randomized controlled trial) to evaluate the impact of the training on primary care physicians\u2019 mental health knowledge, attitudes, and self-efficacy scores, as well as their self-reported practice. We evaluated the training program over the short-term (6 weeks post-training) and over the long-term (18 months post-training).<\/p>\n

Key results from this paper<\/a> include:<\/p>\n