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Jordans MJD, Kohrt BA. Scaling up mental health care and psychosocial support in low-resource settings: a roadmap to impact. Epidemiol Psychiatr Sci 2020; 29:e189. [PMID: 33239113 PMCID: PMC7737188 DOI: 10.1017/s2045796020001018] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/15/2020] [Accepted: 10/24/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Despite recent global attention to mental health and psychosocial support services and a growing body of evidence-support interventions, few mental health services have been established at a regional or national scale in low- and middle-income countries (LMIC). There are myriad challenges and barriers ranging from testing interventions that do not target priority needs of populations or policymakers to interventions that cannot achieve adequate coverage to decrease the treatment gap in LMIC. METHOD We propose a 'roadmap to impact' process that guides planning for interventions to move from the research space to the implementation space. RESULTS We establish four criteria and nine associated indicators that can be evaluated in low-resource settings to foster the greatest likelihood of successfully scaling mental health and psychosocial interventions. The criteria are relevance (indicators: population need, cultural and contextual fit), effectiveness (change in mental health outcome, change in hypothesised mechanism of action), quality (adherence, competence, attendance) and feasibility (coverage, cost). In the research space, relevance and effectiveness need to be established before moving into the implementation space. In the implementation space, ongoing monitoring of quality and feasibility is required to achieve and maintain a positive public health impact. Ultimately, a database or repository needs to be developed with these criteria and indicators to help researchers establish and monitor minimum benchmarks for the indicators, and for policymakers and practitioners to be able to select what interventions will be most likely to succeed in their settings. CONCLUSION A practicable roadmap with a sequence of measurable indicators is an important step to delivering interventions at scale and reducing the mental health treatment gap around the world.
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Affiliation(s)
- Mark J. D. Jordans
- Research & Development, War Child Holland, Amsterdam, the Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Brandon A. Kohrt
- Division of Global Mental Health, Department of Psychiatry & Behavioral Sciences, The George Washington University
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Kaufman KR. BJPsych Open fifth anniversary editorial: history, accomplishments, trajectory and passion. BJPsych Open 2020; 6:e52. [PMID: 32475364 PMCID: PMC7345524 DOI: 10.1192/bjo.2020.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BJPsych Open has come of age. This editorial celebrates the journal's fifth anniversary by reviewing the history of BJPsych Open, what we have accomplished, where we strive to go (our planned trajectory) and the passion of being an Editor-in-Chief.
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Affiliation(s)
- Kenneth R Kaufman
- Departments of Psychiatry, Neurology and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Jersey, USA; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Measuring what matters - information systems for management of chronic disease in primary healthcare settings in low and middle-income countries: challenges and opportunities. Epidemiol Psychiatr Sci 2020; 29:e127. [PMID: 32389151 PMCID: PMC7232121 DOI: 10.1017/s204579602000030x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Effective health information systems are essential to the delivery of high-quality community-based care for chronic disease which will be needed to address the changing healthcare needs of populations in low and middle-income country settings. Health management information systems (health service data collected at facility level) and electronic health records (data organised by individual patients) may support the measurement-based, collaborative approach that is central to the chronic care model, which has been adopted as the basis for task-shared models of care for mental health and non-communicable disease. We used the performance of routine information systems management to guide our commentary on the evidence-base about information systems to support chronic care. We found that, despite an appetite for using the information to support decision-making around service planning, this rarely happens in practice, reasons include that data is not perceived to be of good quality or fit for purpose. There is often a mismatch between technology design and the availability of specialised knowledge and infrastructure. However, when data collection is designed in collaboration with local stakeholders, there is some evidence of success, demonstrated by completion and accuracy of data forms. Whilst there are global targets for the development of health information systems and progress on these is undoubtedly being made, indicators for chronic disease are seldom prioritised by national governments and there is insufficient decentralisation to facilitate local data-driven decision-making. Our recommendations for future research and development, therefore, focus upon the need to integrate context into the design of information systems: through building strong multisectoral partnerships, ensuring newly developed indicators are well aligned to service models and using technology that is a good fit with local infrastructure. This approach will be necessary if information systems are to deliver on their potential to drive improvements in care for chronic disease.
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Ahuja S, Khan A, Goulding L, Bansal RK, Shidhaye R, Thornicroft G, Jordans M. Evaluation of a new set of indicators for mental health care implemented in Madhya Pradesh, India: a mixed methods study. Int J Ment Health Syst 2020; 14:7. [PMID: 32055254 PMCID: PMC7011241 DOI: 10.1186/s13033-020-0341-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Mental health information systems are, in general, inadequate and unreliable in India. We have developed key mental health indicators for measuring mental health service coverage in primary care. This study aims to evaluate the use of these new indicators in seven health care facilities in Sehore District of Madhya Pradesh in India. METHODS The study employed a mixed methods approach. We conducted: a qualitative study (n = 26) with health workers, Health Management Information Systems (HMIS) staff, project coordinators and supervisors; a review of case records (n = 61 at time 1 and n = 74 at time 2); and a structured questionnaire (n = 26) with health workers. The performance, user-friendliness, appropriateness, perceived utility and sustainability of the use of new mental health indicators was assessed. RESULTS High levels of completion, and correctness of completion, of the new mental health indicators were found for the case records. The simplicity of the forms, as well as technical support from the project team, contributed to acceptability and feasibility of implementation. Perceived sustainability of the new forms was, however, affected by the overstretched primary care staff. Further work is needed to support the integration of mental health with routine HMIS. CONCLUSION This study demonstrated that the implementation of key mental health service delivery indicators in Sehore District primary care facilities was feasible. Technical assistance was imperative in maintaining the performance of the indicators over the two studied time points. The integration of mental health indicators in routine health information systems, and political buy-in, are needed to monitor and sustain community mental health programmes in India.
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Affiliation(s)
- Shalini Ahuja
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Azaz Khan
- Programme for Improving Mental Health Care, Sangath, Bhopal India
| | - Lucy Goulding
- Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | | | | | - Graham Thornicroft
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Mark Jordans
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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Kisely S, Siskind D. Meeting the mental health needs of low- and middle-income countries: the start of a long journey. BJPsych Open 2019; 5:e100. [PMID: 31727201 PMCID: PMC6949535 DOI: 10.1192/bjo.2019.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
SUMMARY Mental health is increasingly recognised as an important component of global health. In recognition of this fact, the European Union funded the Emerald programme (Emerging Mental Health Systems in Low- and Middle-Income Countries). The aims were to improve mental health in the following six low- and middle-income countries (LMICs): Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. The Emerald programme offers valuable insights into addressing the mental health needs of LMICs. It provides a framework and practical tools. However, it will be important to evaluate longer-term effects including improvements in mental health outcomes, as well as the applicability to LMICs beyond existing participant countries. Importantly, this must be coupled with efforts to improve health worker retention in LMICs.
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Affiliation(s)
- Steve Kisely
- Professor, School of Medicine, University of Queensland, Princess Alexandra Hospital; Metro South Addiction and Mental Health Service, Australia; and Adjunct Professor, Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada
| | - Dan Siskind
- Associate Professor, School of Medicine, University of Queensland, Princess Alexandra Hospital; and Metro South Addiction and Mental Health Service, Brisbane, Australia
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Ayuso-Mateos JL, Miret M, Lopez-Garcia P, Alem A, Chisholm D, Gureje O, Hanlon C, Jordans M, Kigozi F, Lund C, Petersen I, Semrau M, Shidhaye R, Thornicroft G. Effective methods for knowledge transfer to strengthen mental health systems in low- and middle-income countries. BJPsych Open 2019; 5:e72. [PMID: 31530323 PMCID: PMC6688465 DOI: 10.1192/bjo.2019.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Emerald project's focus is on how to strengthen mental health systems in six low- and middle-income countries (LMICs) (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda). This was done by generating evidence and capacity to enhance health system performance in delivering mental healthcare.A common problem in scaling-up interventions and strengthening mental health programmes in LMICs is how to transfer research evidence, such as the data collected in the Emerald project, into practice. AIMS To describe how core elements of Emerald were implemented and aligned with the ultimate goal of strengthening mental health systems, as well as their short-term impact on practices, policies and programmes in the six partner countries. METHOD We focused on the involvement of policy planners, managers, patients and carers. RESULTS Over 5 years of collaboration, the Emerald consortium has provided evidence and tools for the improvement of mental healthcare in the six LMICs involved in the project. We found that the knowledge transfer efforts had an impact on mental health service delivery and policy planning at the sites and countries involved in the project. CONCLUSIONS This approach may be valid beyond the mental health context, and may be effective for any initiative that aims at implementing evidence-based health policies for health system strengthening.
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Affiliation(s)
- Jose L. Ayuso-Mateos
- Professor of Psychiatry, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid; and Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Maria Miret
- Journalist, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - Pilar Lopez-Garcia
- Associate Professor, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid; Instituto de Investigación Sanitaria Princesa (IIS Princesa); and Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Atalay Alem
- Professor of Psychiatry, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Dan Chisholm
- Programme Manager for Mental Health, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Oye Gureje
- Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa
| | - Charlotte Hanlon
- Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; and Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Mark Jordans
- Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Fred Kigozi
- Senior Consultant Psychiatrist, Butabika National Referral Mental Hospital, Uganda
| | - Crick Lund
- Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Professor of Global Mental Health and Development, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Inge Petersen
- Research Director and Professor, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Maya Semrau
- Research Fellow, Global Health and Infection Department, Brighton and Sussex Medical School; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Rahul Shidhaye
- Clinical Psychiatrist, Public Health Foundation of India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands
| | - Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Psychiatry, King's College London, UK
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Semrau M, Alem A, Ayuso-Mateos JL, Chisholm D, Gureje O, Hanlon C, Jordans M, Kigozi F, Lund C, Petersen I, Shidhaye R, Thornicroft G. Strengthening mental health systems in low- and middle-income countries: recommendations from the Emerald programme. BJPsych Open 2019; 5:e73. [PMID: 31530325 PMCID: PMC6700480 DOI: 10.1192/bjo.2018.90] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a large treatment gap for mental, neurological or substance use (MNS) disorders. The 'Emerging mental health systems in low- and middle-income countries (LMICs)' (Emerald) research programme attempted to identify strategies to work towards reducing this gap through the strengthening of mental health systems. AIMS To provide a set of proposed recommendations for mental health system strengthening in LMICs. METHOD The Emerald programme was implemented in six LMICs in Africa and Asia (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda) over a 5-year period (2012-2017), and aimed to improve mental health outcomes in the six countries by building capacity and generating evidence to enhance health system strengthening. RESULTS The proposed recommendations align closely with the World Health Organization's key health system strengthening 'building blocks' of governance, financing, human resource development, service provision and information systems; knowledge transfer is included as an additional cross-cutting component. Specific recommendations are made in the paper for each of these building blocks based on the body of data that were collected and analysed during Emerald. CONCLUSIONS These recommendations are relevant not only to the six countries in which their evidential basis was generated, but to other LMICs as well; they may also be generalisable to other non-communicable diseases beyond MNS disorders. DECLARATION OF INTEREST None.
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Affiliation(s)
- Maya Semrau
- Research Fellow in Implementation Research, Centre for Global Health Research, Brighton and Sussex Medical School; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Atalay Alem
- Professor, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Jose L. Ayuso-Mateos
- Chairman and Director, Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid; and Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Dan Chisholm
- Programme Manager for Mental Health, Regional Office for Europe, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
| | - Oye Gureje
- Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa
| | - Charlotte Hanlon
- Reader in Global Mental Health, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Adjunct Associate Professor, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Mark Jordans
- Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Fred Kigozi
- Senior Consultant Psychiatrist and Researcher, Butabika National Referral and Teaching Hospital, Uganda
| | - Crick Lund
- Professor of Public Mental Health, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Professor of Global Mental Health and Development, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Inge Petersen
- Research Professor and Director, Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Rahul Shidhaye
- Clinical Psychiatrist, Public Health Foundation of India; and CAPHRI School for Public Health and Primary Care, Maastricht University, the Netherlands
| | - Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Psychiatry, King's College London, UK
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Ahuja S, Hanlon C, Chisholm D, Semrau M, Gurung D, Abdulmalik J, Mugisha J, Mntambo N, Kigozi F, Petersen I, Shidhaye R, Upadhaya N, Lund C, Evans-Lacko S, Thornicroft G, Gureje O, Jordans M. Experience of implementing new mental health indicators within information systems in six low- and middle-income countries. BJPsych Open 2019; 5:e71. [PMID: 31530321 PMCID: PMC6688459 DOI: 10.1192/bjo.2019.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Successful scale-up of integrated primary mental healthcare requires routine monitoring of key programme performance indicators. A consensus set of mental health indicators has been proposed but evidence on their use in routine settings is lacking. AIMS To assess the acceptability, feasibility, perceived costs and sustainability of implementing indicators relating to integrated mental health service coverage in six South Asian (India, Nepal) and sub-Saharan African countries (Ethiopia, Nigeria, South Africa, Uganda). METHOD A qualitative study using semi-structured key informant interviews (n = 128) was conducted. The 'Performance of Routine Information Systems' framework served as the basis for a coding framework covering three main categories related to the performance of new tools introduced to collect data on mental health indicators: (1) technical; (2) organisation; and (3) behavioural determinants. RESULTS Most mental health indicators were deemed relevant and potentially useful for improving care, and therefore acceptable to end users. Exceptions were indicators on functionality, cost and severity. The simplicity of the data-capturing formats contributed to the feasibility of using forms to generate data on mental health indicators. Health workers reported increasing confidence in their capacity to record the mental health data and minimal additional cost to initiate mental health reporting. However, overstretched primary care staff and the time-consuming reporting process affected perceived sustainability. CONCLUSIONS Use of the newly developed, contextually appropriate mental health indicators in health facilities providing primary care services was seen largely to be feasible in the six Emerald countries, mainly because of the simplicity of the forms and continued support in the design and implementation stage. However, approaches to implementation of new forms generating data on mental health indicators need to be customised to the specific health system context of different countries. Further work is needed to identify ways to utilise mental health data to monitor and improve the quality of mental health services. DECLARATION OF INTEREST None.
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Affiliation(s)
- Shalini Ahuja
- Researcher, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Charlotte Hanlon
- Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Dan Chisholm
- Programme Manager, Department of Mental Health and Substance Abuse, World Health Organization, Switzerland
| | - Maya Semrau
- Research Fellow, Global Health and Infection Department, Brighton & Sussex Medical School, UK; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Dristy Gurung
- Researcher and Programme Coordinator, Transcultural Psychosocial Organization, Nepal
| | | | - James Mugisha
- Researcher, Kyambogo University; and Butabika National Referral and Teaching Mental Hospital, Uganda
| | - Ntokozo Mntambo
- Researcher, School of Applied Human Sciences, University of Kwazulu-Natal, South Africa
| | - Fred Kigozi
- Senior Researcher, Butabika National Referral and Teaching Mental Hospital, Uganda
| | - Inge Petersen
- Research Director and Professor, Centre for Rural Health, School of Nursing and Public Health, University of Kwazulu-Natal, South Africa
| | - Rahul Shidhaye
- Senior Researcher, Centre for Mental Health, Public Health Foundation of India, India
| | | | - Crick Lund
- Professor, Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sara Evans-Lacko
- Associate Professorial Research Fellow, Personal Social Services Research Unit, London School of Economics and Political Science; and Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Oye Gureje
- Professor of Psychiatry and Director, WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Nigeria; and Professor Extraordinary, Department of Psychiatry, Stellenbosch University, South Africa
| | - Mark Jordans
- Reader, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Thornicroft G, Semrau M. Health system strengthening for mental health in low- and middle-income countries: introduction to the Emerald programme. BJPsych Open 2019; 5:e66. [PMID: 31685066 PMCID: PMC6688463 DOI: 10.1192/bjo.2019.9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 01/09/2023] Open
Abstract
This paper gives an overview of the Emerald (Emerging mental health systems in low- and middle-income countries) programme and introduces the subsequent seven papers in this BJPsych Open thematic series. The aims of the Emerald research programme were to improve mental health outcomes in six low- and middle-income countries (LMICs), namely Ethiopia, India, Nepal, Nigeria, South Africa and Uganda, by building capacity and by generating evidence to enhance health system strengthening in these six countries. The longer-term aim is to improve mental healthcare, and so contribute to a reduction in the large treatment gap that exists for mental disorders. This series includes papers describing the following components of the Emerald programme: (a) capacity building; (b) mental health financing; (c) integrated care (d) mental health information systems; and (e) knowledge transfer. We also include a cross-cutting paper with recommendations from the Emerald programme as a whole. The inclusion of clear mental-health-related targets and indicators within the United Nations Sustainable Development Goals now intensifies the need for strong evidence about both how to provide effective treatments, and how to deliver these treatments within robust health systems.
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Affiliation(s)
- Graham Thornicroft
- Professor of Community Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Maya Semrau
- Research Fellow in Implementation Research, Centre for Global Health Research, Brighton and Sussex Medical School; and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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