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Agudelo-Hernández F, Plata-Casas L, Vélez Botero H, Salazar Vieira LM, Moreno Mayorga B. [Mental Health Gap Action Programme: a theoretical model of barriers to implementation by health personnel in Chocó, ColombiaPrograma de Ação para Reduzir as Lacunas em Saúde Mental: modelo teórico das barreiras de implementação por profissionais de saúde de Chocó, Colômbia]. Rev Panam Salud Publica 2024; 48:e49. [PMID: 38779536 PMCID: PMC11110682 DOI: 10.26633/rpsp.2024.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Objectives Mental, neurological, and substance use (MNS) disorders have a high prevalence in Colombia and there is a treatment gap. The World Health Organization (WHO) Mental Health Gap Action Programme (mhGAP) has various components. The mhGAP 2.0 Intervention Guide, aimed at improving primary health care, is a guide for the assessment and management of MNS disorders based on clinical decision-making protocols. The objective of this study was to determine the barriers that may hinder the program implementation process. Methods A qualitative study with content analysis was conducted in three phases: i) study preparation, organization, and presentation; ii) open coding, categorization, and abstraction of contents; and iii) information analysis. The study included semi-structured interviews with 21 people involved in the provision of mental health services in Chocó (Colombia): five medical doctors, seven nurses, and three psychologists, as well as six professionals working in the administrative area of the department's health secretariats. The perceptions of these stakeholders were explored. Open-ended questions were asked to explore experiences with the process, as well as the barriers identified in practice. Results Four different thematic categories were identified: intersectoral action, long-standing challenges, opportunities, and suitability of tools. Conclusions A theoretical model of barriers to implementation of the mhGAP program was constructed, based on stakeholder perceptions. Controlling barriers is perceived as a possible way to contribute significantly to population health.
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Affiliation(s)
- Felipe Agudelo-Hernández
- Facultad de Ciencias de la Salud Universidad de Manizales Caldas Colombia Facultad de Ciencias de la Salud, Universidad de Manizales, Caldas, Colombia
| | - Laura Plata-Casas
- Ministerio de Salud y Protección Social Bogotá Colombia Ministerio de Salud y Protección Social, Bogotá, Colombia
| | - Helena Vélez Botero
- Universidad Nacional de Colombia Bogotá Colombia Universidad Nacional de Colombia, Bogotá, Colombia
| | - Luz María Salazar Vieira
- Universidad Nacional de Colombia Bogotá Colombia Universidad Nacional de Colombia, Bogotá, Colombia
| | - Bibian Moreno Mayorga
- Ministerio de Salud y Protección Social Bogotá Colombia Ministerio de Salud y Protección Social, Bogotá, Colombia
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Nori-Sarma A, Galea S. Climate change and mental health: a call for a global research agenda. Lancet Psychiatry 2024; 11:316-317. [PMID: 38631783 DOI: 10.1016/s2215-0366(24)00098-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Amruta Nori-Sarma
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA.
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston MA, USA
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Sapag JC, Mancevski A, Perry A, Norman CD, Barnsley J, Ferris LE, Rush B. Developing and Testing an Evaluation Framework for Collaborative Mental Health Services in Primary Care Systems in Latin America. Community Ment Health J 2024; 60:426-437. [PMID: 37815700 DOI: 10.1007/s10597-023-01186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/05/2023] [Indexed: 10/11/2023]
Abstract
To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed.
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Affiliation(s)
- Jaime C Sapag
- Departments of Public Health and Family Medicine, Division of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Division of Public Health and Family Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362 (Second Floor), Piso 2 (Salud Pública)-Comuna de Santiago, 8330077, Santiago, Chile.
| | | | - Andrés Perry
- Departments of Public Health and Family Medicine, Division of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cameron D Norman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Cense Ltd., Toronto, ON, Canada
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lorraine E Ferris
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brian Rush
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Hannon E, Anselimus SM, Bardikoff N, Bulc B, Germann S, Gonsalves PP, Melendez-Torres GJ, Ospina-Pinillos L, Sinha M, Wanjiru M. Why cities matter for adolescent mental health and wellbeing. Lancet 2024; 403:708-710. [PMID: 37827186 DOI: 10.1016/s0140-6736(23)02238-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Affiliation(s)
| | - Sweetbert M Anselimus
- Tanzania's Psychosocial Welfare Organization, and University of Dar es Salaam, Iringa, Tanzania
| | - Nicole Bardikoff
- Global Mental Health at Grand Challenges Canada, Toronto, ON, Canada
| | - Barbara Bulc
- Global Development and SDG CoLab, Geneva, Switzerland
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Gray B, Asrat B, Brohan E, Chowdhury N, Dua T, van Ommeren M. Management of generalized anxiety disorder and panic disorder in general health care settings: new WHO recommendations. World Psychiatry 2024; 23:160-161. [PMID: 38214633 PMCID: PMC10785994 DOI: 10.1002/wps.21172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Affiliation(s)
- Brandon Gray
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Biksegn Asrat
- Department of Psychiatry, Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- UK Public Health Rapid Support Team, UK Health Security Agency/London School of Hygiene and Tropical Medicine, London, UK
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elaine Brohan
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Neerja Chowdhury
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Aggarwal S, Armstrong G. How, when and where to intervene in self-harm in youth in low- and middle-income countries: Thinking beyond healthcare systems. Int J Soc Psychiatry 2023; 69:1837-1839. [PMID: 37162034 PMCID: PMC7615317 DOI: 10.1177/00207640231174368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Low- and middle-income countries (LMICs) account for 78% of global suicides. Self-harm is the clearest antecedent of suicide. The health and social systems have struggled to provide adequate evidence based help to young people with self-harm. In addition, the negative attitudes towards those who self-harm in these settings interfere with help-seeking behaviour. AIMS AND METHOD In our submission of a comment, we discuss the reasons for thinking beyond healthcare systems in LMICs to address self-harm in youth and the possible ways to achieve it. RESULTS AND CONCLUSION We truly believe that harnessing the potential of social systems such as schools is important for addressing self-harm in LMICs. We present our arguments in favour of feasible measures that can be implemented to achieve this.
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Affiliation(s)
- Shilpa Aggarwal
- Public Health Foundation of India, New Delhi, India
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Mellbourne, VIC, Australia
- Faculty of Health, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Greg Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Agudelo-Hernández F, García Cano JF, Salazar Vieira LM, Vergara Palacios W, Padilla M, Moreno Mayorga B. [Gaps in primary mental health care in Chocó, Colombia: barriers and challengesLacunas na atenção primária à saúde mental em Chocó, Colômbia: barreiras e desafios]. Rev Panam Salud Publica 2023; 47:e138. [PMID: 37881801 PMCID: PMC10597394 DOI: 10.26633/rpsp.2023.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 10/27/2023] Open
Abstract
Objective Describe barriers and challenges in the implementation of the global Mental Health Gap Action Program (mhGAP), and determine the association between facilitators of implementation, accessibility, acceptability, and supervision, in Chocó, Colombia. Methods Cross-sectional evaluation study, with mixed and sequential methods. Forty-one people participated: 30 health personnel and 11 administrative workers. Five focus groups were formed within the framework of the mhGAP training. The Likert scale of implementation drivers was used to determine factors affecting the strategy, such as system facilitators, accessibility of the strategy, adaptation and acceptability, and training and supervision. Semi-structured interviews were also conducted, with a subsequent thematic analysis. Results A statistically significant correlation was found between the components of implementation. This was reaffirmed by the information from the interviews. Notable barriers include dispersion, armed conflict, difficulty in changing one's perspective on the area where they live, and administrative problems in accessing treatment. These factors are addressed in a proposed care pathway. Conclusions With respect to mhGAP in the department of Chocó, despite adequate acceptability, access, and supervision, there are barriers and challenges at the social, geographical, political, cultural, and health administration levels, which could be overcome through implementation of locally-built intersectoral recovery routes.
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Affiliation(s)
- Felipe Agudelo-Hernández
- Organización Panamericana de la SaludBogotáColombiaOrganización Panamericana de la Salud, Bogotá. Colombia.
| | - Juan Fernando García Cano
- Organización Panamericana de la SaludBogotáColombiaOrganización Panamericana de la Salud, Bogotá. Colombia.
| | - Luz María Salazar Vieira
- Organización Panamericana de la SaludBogotáColombiaOrganización Panamericana de la Salud, Bogotá. Colombia.
| | - Wendy Vergara Palacios
- Secretaria de Salud de QuibdóChocóColombiaSecretaria de Salud de Quibdó, Chocó, Colombia.
| | - Mónica Padilla
- Organización Panamericana de la SaludBogotáColombiaOrganización Panamericana de la Salud, Bogotá. Colombia.
| | - Bibian Moreno Mayorga
- Ministerio de Salud y Protección SocialBogotáColombiaMinisterio de Salud y Protección Social, Bogotá, Colombia.
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Abstract
The field of global mental health (GMH) has undergone profound changes over the past decade. Outgrowing its earlier agenda it has performed a reflexive turn, broadened towards a social paradigm and developed new modes of knowledge production, all of which reshaped 'mental health' as a global object of knowledge and care, and the epistemic politics of the field. Drawing on long-term ethnographic fieldwork among GMH experts and recent agenda-setting publications, I discuss how GMH advocates and critical observers alike have created conceptual and practical middle-grounds between different forms of mental health knowledge - across culture, epistemic power, lived experience, policy platforms and academic disciplines - framing their dynamic encounters as dialogue, adaptation, participation, co-production or integration. Ultimately, I argue, GMH today is focusing less on establishing mental health as a universal problem than on managing its inherent multiplicity through alignment and integration across different bodies of knowledge. Global knowledge, so conceived, is fluid and malleable and produced in open-ended knowledge practices, governed by what I call 'contingent universality'. It is not new that the concepts and practices of the psy-disciplines are malleable and multiple, internally and externally contested, rapidly changing over time and not easily transferrable across space. What is new is that within the increasingly heterogenous epistemic space of GMH, these features have become assets rather than liabilities. GMH knowledge achieves both global reach and local relevance precisely because 'mental health' can be many things; it can be expressed in a wide range of idioms and concepts, and its problems and solutions align easily with others, at many scales. These fluid and integrative knowledge practices call for renewed empirical, critical and collaborative engagement.
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Hernández Rincón EH, Tuesca Molina R, Guerrero Espinel E, Gutiérrez González H, Agudelo N, Listovsky G. Desarrollo profesional permanente en salud por intermedio del Campus Virtual de Salud Pública en Colombia (2012-2019). Rev Panam Salud Publica 2022; 46:e105. [PMID: 36060202 PMCID: PMC9426955 DOI: 10.26633/rpsp.2022.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/09/2022] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Reconstruir la experiencia del Campus Virtual de Salud Pública (CVSP) desde el año 2012 al 2019 en Colombia. Métodos. Se realizó la sistematización de la experiencia del proceso de formación en salud pública para Colombia, por intermedio del Campus para el periodo de 2012 a 2019. La información se presenta en series transversales de periodos de tiempo para visibilizar la evolución histórica del CVSP en Colombia. Resultados. Se han capacitado 2 627 profesionales de la salud en cursos con tutoría y 34 012 en cursos de autoaprendizaje en temáticas relevantes, actualizadas y prioritarias en salud pública. Se destaca la oportunidad y acceso a regiones remotas que ha tenido el Campus mediante procesos de formación sin costo para el usuario final. La experiencia destaca la relevancia del Campus en la reducción de la brecha de actualización del talento humano en salud, mediante procesos de educación virtual, con diversidad en la modalidad y en la oferta formativa. Conclusiones. La reconstrucción de la experiencia en Colombia mostró la evolución y fortalecimiento del CVSP para ofertar procesos de formación con calidad para responder a los problemas y necesidades del país; la consolidación del Campus se debió al trabajo colaborativo entre las universidades y la Organización Panamericana de la Salud.
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